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How to hide medical treatment from your health plan
You have your reasons for not wanting your health plan to know you were tested for the breast cancer gene or that you had cosmetic surgery.
New regulations from the U.S. Department of Health and Human Services should make it easier for you to hide care from your health plans if you so desire. The new regulations are an update to the Health Insurance Portability and Accountability Act (HIPAA).
The rules add "business associates" to those responsible for protecting the privacy of patients under HIPAA. That means that anyone who handles your health records must protect your privacy. And anyone who breeches the new rules is subject to fines of up to $1 million.
The new regulations were announced in the Federal Register in January 2013 and took effect in late March. However, health insurers, health providers and their business associates were given a grace period and had until Sept. 23 to comply.
Still, many hospitals, doctors and their staff may not be familiar with the new regulations and they could easily let it slip to your insurance company that you were treated, especially when they are looking for payment.
Here's what you need to do if you want to keep your treatment secret.
Pay cash. That's the most important step you can take if you want to hide treatment from your health plan, says Dr. Dike Drummond, a family physician who provides burnout prevention and treatment services for health care professionals at his website, thehappymd.com.
When you pay cash, your health care provider has no reason to submit your claim to your health plan, Drummond says. If you pay cash, do so upfront, at the time of treatment, so there's no question when it comes to the doctor's office getting reimbursed. Nobody will send your health insurance a bill because there isn't one.
Another benefit of paying cash is that you could get a significant discount, Drummond says. Health plans negotiate discounts with hospitals, doctors and other health care providers. They pay less for that CT scan or chest X-ray than the list price. Still, the negotiated prices for their insurance customers can be significantly higher than what you would pay as a cash customer, Drummond says.
The providers may want to bill your insurance because they could get more than if you paid cash. So Drummond advises asking the cash price when you book your appointment.
Drummond recommends also paying cash for all related care if you can. It can get tricky if you allow your health plan to pay for the chest X-ray you need before you can have breast implants, if you don't want your health insurance to know about the implants.
Don't tell. If you don't tell your doctor or hospital that you have health insurance, no one in billing can mistakenly submit your claim to your plan. However, come 2014, under Obamacare, everyone is required to have health insurance. So your health care providers may not believe you if you say you don't have health insurance, or don't want to reveal which insurance you have, Drummond says.
Put it in writing. "You can say to your doctor, 'I want my having this procedure or test kept confidential. Do not tell my insurance company,'" says Lisa Zamosky, author of "Health Care, Insurance and You: The Savvy Consumer's Guide. "
A simple verbal request should be sufficient, says Zamosky, who is also a columnist for the Los Angeles Times and health reform expert for WebMD. However, she says, as backup, put your request in writing to prevent anyone in your provider's office from missing the request and submitting information to your insurance company. Clearly state that you are requesting what you're having done be kept confidential. Ask that your request be attached to your chart or scanned and added to your electronic medical record, Zamosky says.
A lot of doctors' offices use third-party billing services. That could make keeping your treatment a secret a little more difficult, Zamosky says. Besides telling your provider, you should ask whether you need to tell anyone else in the office or in billing to be sure no one inadvertently messes up.
Drugs can be secret, too
Don't forget the pharmacist. Under HIPAA, you have the right to ask your pharmacist not to tell your health insurance company about any drugs you take. Again, pay in full so the provider or pharmacy does not need to get paid by your insurance company.
Consider consequences of secrets
Zamosky says some patients don't want their health insurance to know about certain treatments or drugs they take for fear they will be denied health insurance or employment. However, she says, under Obamacare, you can't be denied health insurance for a pre-existing condition, beginning Jan. 1, 2014. So that concern may become obsolete.
Keep in mind, Drummond says, if your health plan doesn't know about treatments you paid for out of pocket, the money you spent won't count toward your deductible. So you may want to seriously consider your reasons for keeping your care private, he says.
More from Beth Orenstein here