RE: health insurance for individuals?

[Gregory P Sweet <gps03 -at- health -dot- state -dot- ny -dot- us>]

> [snip]
>
> I had a 3-month exclusion
> period where I could not be seen for anything related to my medical
> condition.  They even denied giving me results for a blood test from
> December until February when the exclusion period ended that showed I
> was
> moderately anemic.  I could have really used that information.
>
> ----------------------------------------------------------
>
> Wonderful. And what if those results they denied you had shown you had a
> condition that was fatal if not corrected immediately? I can't believe
> how these organizations are so caught up in procedures and bureaucracy
> that they would put a person's life at stake. Is there any type of legal
> recourse one has in a case like that?
> ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Unless this happened outside of the United States, or previous to enactment
of the HIPPA laws they could not deny providing a test result. They could
deny paying for the test, the physician/lab could demand payment for the
consultation, but a result to medical test is part of your medical record
and under Federal law the provider must, without fail:
1. Provide your medical record for you to examine, free of charge.
2. Provide a private location for you to examine your record, free of
charge.

You may not remove the record from the premises, unless the record holder
agrees that you may (they are responsible for keeping it for seven years.
The holder of the record gets 30 days to produce the record and may charge
an outrageous fee ($2.00/page IIRC) for copies of the records for you to
keep or be sent to you.

Either way test results are your protected health information (PHI) and
cannot be withheld from you, regardless of your ability to pay.

The legal recourse would be to file a complaint with HHS:
http://www.hhs.gov/ocr/privacyhowtofile.htm

Now of course if the insurer was saying that the outcome of that test could
impact your eligibility, then it was up to you as a consumer to decide
whether the knowledge of the test result outweighed the risk of possibly
reducing your eligibility. It's a crappy system, but it's legal...right
now. I can sympathize too, I once had an insurer deny coverage for a
pathology test because the result was negative. In their view negative
results indicated an unnecessary test. They real kick-in-the-crotch is
that, at the time I was employed by the insurer!

-Greg


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