A New Law in TX Allows Employers to View Employee Medical Records
- Thread starter SparklingWaves
- Start date
SparklingWaves
Well-known member
This law is very disturbing to me. (BTW- I don't live in TX). That's not the point here. There is a much bigger issue that is going on that's not even mentioned. I guess. They don't want to say it.
redambition
Well-known member
my, what an uninformative site. i was trying to get some more details on what exactly this change entails without watching the video, but only found a brief summary with nowhere enough detail for my liking.
all i could see is that an employer can see what has been spent on the company health insurance plan, but apparently they won't have access to the employee's names.
does anyone have some more info on this? i'm not sure what would be a reliable source.
all i could see is that an employer can see what has been spent on the company health insurance plan, but apparently they won't have access to the employee's names.
does anyone have some more info on this? i'm not sure what would be a reliable source.
COBI
Well-known member
According to related links off that site, they will have access to dates, diagnosis(es) and amounts, but not employee names.
From there I was able to link an article on the state of Texas (http://www.hro.house.state.tx.us/PDF/ba80r/HB2015.PDF) which provides an "analysis" of HB 2015. From the article, it is clearly stated that nothing that would violate Federal HIPAA laws could be provided. From reading the article on the Texas site, this information was ALREADY available to employers, but HB 2015 seems to change the format and timeliness of the report.
I know in NH, we, too, can receive claim reports (such as totals, category of diagnosis, etc.) It's actually an important control report as your future premiums are based on current claims, so if a company weren't able to see claim totals and information (not employee detail), how would any of know if the premium increases by the insurance companies were based on legitimate cost increases?
Now, our reports (in NH) are not very detailed at all, at least the ones we see. We essentially get totals by category (such as oncology, regular checkups, prescription totals, diabetic treatments, etc.) as well as the number of claimants within each category. Generally, when we see 2 oncology claim sets, we already know which 2 employees had cancer treatments during the prior year. When we see, 1 claim set for prenatal care, we know which employee had a preemie that required substantial medical care. There really aren't many surprises. I don't if it's available to us monthly, but I know we don't ask for it. Our insurance company usually does it annually as part of our standard management reports.
I think that when you read what is available, you'll see it's not new and it can't violate the HIPAA laws. I get aggravated when news stories take on an alarmist angle and provide a biased angle on what should be a news story by leaving out key points.
From the Texas article http://www.hro.house.state.tx.us/PDF/ba80r/HB2015.PDF:
"CS HB 2015 would repeal Art. 21.49-15, ch. 1209, and sec. 1501.614 of the Insurance Code and establish new claims reporting requirements for health insurance plan carriers that contract with employers.Within 30 days of a request by an employer, a plan issuer would have to provide a report containing all of the information that was responsive tothe request, including protected health information except information subject to certain privacy restrictions, for the 36-month period preceding the date of the report, or under other time periods specified in the bill.
The report would have to include:
- aggregate paid claims experience by month, including claims experience for medical, dental, and pharmacy benefits, as applicable;
- total premium paid by month;
- total number of covered employees on a monthly basis by coverage tier;
- the total dollar amount of claims pending as of the date of the report;
- a separate description and individual claims report for any individual whose total paid claims exceeded $15,000 during the 12-month period preceding the date of the report, including the following information — a unique identifying number or code forthe individual, the amounts paid, dates of service, and applicable procedure codes; and for claims that were not part of the report, a statement of precertification requests for hospital stays of five days or longer made during the 30 days preceding the date of the report.
A health insurance issuer could not disclose protected health information if prohibited by federal or state laws that impose more stringent privacy requirements than those imposed under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)."
From there I was able to link an article on the state of Texas (http://www.hro.house.state.tx.us/PDF/ba80r/HB2015.PDF) which provides an "analysis" of HB 2015. From the article, it is clearly stated that nothing that would violate Federal HIPAA laws could be provided. From reading the article on the Texas site, this information was ALREADY available to employers, but HB 2015 seems to change the format and timeliness of the report.
I know in NH, we, too, can receive claim reports (such as totals, category of diagnosis, etc.) It's actually an important control report as your future premiums are based on current claims, so if a company weren't able to see claim totals and information (not employee detail), how would any of know if the premium increases by the insurance companies were based on legitimate cost increases?
Now, our reports (in NH) are not very detailed at all, at least the ones we see. We essentially get totals by category (such as oncology, regular checkups, prescription totals, diabetic treatments, etc.) as well as the number of claimants within each category. Generally, when we see 2 oncology claim sets, we already know which 2 employees had cancer treatments during the prior year. When we see, 1 claim set for prenatal care, we know which employee had a preemie that required substantial medical care. There really aren't many surprises. I don't if it's available to us monthly, but I know we don't ask for it. Our insurance company usually does it annually as part of our standard management reports.
I think that when you read what is available, you'll see it's not new and it can't violate the HIPAA laws. I get aggravated when news stories take on an alarmist angle and provide a biased angle on what should be a news story by leaving out key points.
From the Texas article http://www.hro.house.state.tx.us/PDF/ba80r/HB2015.PDF:
"CS HB 2015 would repeal Art. 21.49-15, ch. 1209, and sec. 1501.614 of the Insurance Code and establish new claims reporting requirements for health insurance plan carriers that contract with employers.Within 30 days of a request by an employer, a plan issuer would have to provide a report containing all of the information that was responsive tothe request, including protected health information except information subject to certain privacy restrictions, for the 36-month period preceding the date of the report, or under other time periods specified in the bill.
The report would have to include:
- aggregate paid claims experience by month, including claims experience for medical, dental, and pharmacy benefits, as applicable;
- total premium paid by month;
- total number of covered employees on a monthly basis by coverage tier;
- the total dollar amount of claims pending as of the date of the report;
- a separate description and individual claims report for any individual whose total paid claims exceeded $15,000 during the 12-month period preceding the date of the report, including the following information — a unique identifying number or code forthe individual, the amounts paid, dates of service, and applicable procedure codes; and for claims that were not part of the report, a statement of precertification requests for hospital stays of five days or longer made during the 30 days preceding the date of the report.
A health insurance issuer could not disclose protected health information if prohibited by federal or state laws that impose more stringent privacy requirements than those imposed under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)."
