Anyone care to explain how this changes what an agent has to do:
HHS explains how to hide care from health plans | LifeHealthPro
HHS explains how to hide care from health plans | LifeHealthPro
New HIPAA Rules for Agents
- Thread starter Yagents
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The article says, "When patients pay for medical care out of pocket, they should be able to keep doctors and hospitals from telling their health insurers about the care."
Hopefully they will draw a clearer line, and confirm that this does not allow an applicant to lie on an application. I often have applicants say, "Well, I didn't submit a claim for that, so do I have to disclose it on the application?". To which I say that the question didn't ask who paid the cost, it just asked if you had the condition, received treatment or medical advice for it.
Hopefully they will draw a clearer line, and confirm that this does not allow an applicant to lie on an application. I often have applicants say, "Well, I didn't submit a claim for that, so do I have to disclose it on the application?". To which I say that the question didn't ask who paid the cost, it just asked if you had the condition, received treatment or medical advice for it.
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That was pretty much my thought on this. Why do you need to hide health information from an insurer other than to be able to lie on the application? Unless the insurer is also your employer, I can see no sound reason you should need to hide that information.
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Richard Sampson Jr. MD. • an hour ago
Richard Sampson Jr. MD. • an hour ago
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I think the only material thing that patients would want to hide from the MIB, Insurers and their agents is if they SMOKE. After this year, there can be no other rate-ups..or riders.
As usual with a government agency, HHS is behind the curve. When they started working on this 560 page rule, it was 2009 and ObamaCare was far from becoming law.
-ac
As usual with a government agency, HHS is behind the curve. When they started working on this 560 page rule, it was 2009 and ObamaCare was far from becoming law.
-ac
Cash payments for doc visits, Rx, etc do not show up in MIB records or Rx history (such as Milliman Inteliscripts). If an applicant has seen a doc for a condition, been diagnosed, had a suggested treatment plan or Rx written and filled . . . all on a cash basis, it is entirely possible for that person to file a fraudulent app and possibly get away with it.
Of course if they tell the agent . . .
Ed, you got a working link for that quote? The one you provided goes to the LH Pro site
Of course if they tell the agent . . .
Ed, you got a working link for that quote? The one you provided goes to the LH Pro site
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d.e.a.t.h. p.a.n.n.l.e.
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Bob...I just copied and pasted a comment.
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In essence, HHS is saying that the MIB isn't as worthwhile as it really seems.
Even though we are worried about fraud committed on an application, I think there is at least one sound reason for this.
I've always been wary of an insurance company's "wellness" online surveys that are a paper-thin cover-up for finding out the patient's height & weight, smoking habits, eating habits, genetic influences etc. I know most of you don't do group insurance, but here in AZ, a group of 25 or more employees does not need to complete a health questionnaire at the initial application (the Employer completes a "to the best of the employer's knowledge and belief" health statement for the group). For groups of 2-24 there is a simplified universal questionnaire that looks back 5 years only. So, insurers are looking for other ways to predict claims, and those thinly disguised wellness programs are one way to do it.
Also, at claim time, some insurers are asking the doctors for more information. As a "medically necessary" investigation, they are also gleaning background information that tells them the deeper risk involved.
I've always been wary of an insurance company's "wellness" online surveys that are a paper-thin cover-up for finding out the patient's height & weight, smoking habits, eating habits, genetic influences etc. I know most of you don't do group insurance, but here in AZ, a group of 25 or more employees does not need to complete a health questionnaire at the initial application (the Employer completes a "to the best of the employer's knowledge and belief" health statement for the group). For groups of 2-24 there is a simplified universal questionnaire that looks back 5 years only. So, insurers are looking for other ways to predict claims, and those thinly disguised wellness programs are one way to do it.
Also, at claim time, some insurers are asking the doctors for more information. As a "medically necessary" investigation, they are also gleaning background information that tells them the deeper risk involved.
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