HIPAA Drama: How Access Can Be Hindered

One of my tasks with all new clients is to get a HIPAA  and personal representative form filled out.  These forms when signed by the client, authorize me to speak with  medical teams, hospitals, administrators, billing offices and insurance companies.  It is the key to my work as an advocate.  There should be no problem after I submit it to the appropriate person.

I could only wish it was always that easy.  I have learned to have patience and steel determination to get any HIPAA form into a system.  I have experienced a variety of reactions from being accused of the HIPAA form being forged to being told it would take 30 days to get it in the system.

One time, when a court had instructed the family of a nursing home patient to hire a patient advocate and the nursing home administration to allow it, I presented my HIPAA to visit the patient.  The nurse on duty started screaming (not making this up) that this was a forgery and I was not allowed in the building. I calmly told her to call her supervisor, who came and said the facilities lawyers would have to review it.  It was not pleasant.  After five days of being told the lawyers hadn’t decided whether to accept it, I contacted the state Ombudsperson who immediately contacted the facility.  The next day, I was visiting the patient.

I regularly submit personal representative forms to insurance companies.  On the average it takes two -seven days to get into the system. If it is not in by then, I usually have to call daily and speak with a supervisor.  Recently, I called Blue Cross Blue Shield of MA (I call frequently) and was told the new policy was thirty days to get a form into the system.  I was stunned and annoyed.  I immediately asked for a supervisor and was told yes, it can take that long, but generally it doesn’t take that much time.  I was told the client could call  to allow me to speak with them for just that day.  Talk about inconvenience!

This is such a barrier to the client who may need immediate assistance.  How can it possibly take up to thirty days?  One supervisor told me, they actually don’t get many personal representative forms.  However, the forms have to go through the security department, be scrutinized for all the correct information and then uploaded.  The security department has the right, by BCBS policy, to keep it on a desk for up to 30 days.

In another case, I was helping a family deal with bills after the death of the patient.  The couple had never gotten power of attorney papers, so by law , the surviving spouse oversees the estate and is responsible for bills.  I had HIPAA forms signed.  One billing department refused to even deal with the husband because he didn’t have power of attorney papers.  I had even sent a death certificate.  Who exactly were they protecting especially when the family was trying to resolve the bill?

HIPAA has become the elephant in the room.  It is a barrier to patients to get assistance and information.  Facilities have created layers and layers to wade through to get information, medical records and answers.  To make things worse, every institution has their own regulations and forms. I understand that privacy and regulation are an important part of patient care, but I would advocate for standardization of forms, in both medical facilities and insurance companies.  I fear, though, it is only going to get more difficult.