HIPAA Q...Long, sorry!
Hey ladies
Long story short, I have been having issues with our MTF. I obviously paid 100% OOP for our IVF and recently graduated to an OB. I called Tricare directly and was told that I only needed to provide my Beta's to the MTF for my referral.
I left several messages and no one would return my call at the MTF. Finally I gave up the losing battle and went for the stupid pee test, even though Tricare confirmed 3 seperate times that was NOT their policy.
Went to the clinic, the lab guy was incredibly rude to me. As was the OB referal speciality lady, whatever her title is. She procedes to tell me that the Base commander has mandated this "class" for all pregnant women to take explaining Tricare. And of course, it's like 5 hours and during the work day. Yeah right.
I asked what would happen if I didn't do it, she replied, we call your H's first shirt.
Fast Fwd to today, the Col. of Med Group called my H's first shirt. He was "concerned" that we were not following the referral rules and would have to pay OOP. YEAH RIGHT.
I am sorry, but FIRST OFF, my husbands command did NOT know we were pregnant yet. Also, I AM NOT AD. How in the hell did he have the right to call someone and hand out MY private Health Info??
I have called Tricare and they couldn't really tell me much except to call my advocate at the clinic, which of course is going to cause more issues than fix anything.
It's so unfair that the Med Group is not responsible for their actions because they have absolute job security and can talk to me however they like.
What do I do? I am so upset that my medical information was so easily thrown about and also that now my H is having to answer to his First Shirt.
Does anyone know if I have any rights under HIPAA? I read a few things but I feel almost certain that the military has a loop hole in there that they can pretty much do whatever they want.
IUI#1-April 2010- Clomid 100mg, Ovidrel and timed intercourse= BFN
IUI #2- Cancelled due to cysts
IUI #3- June 2010- Clomid, Ovidrel and timed intercourse= BFN
Break due to DH deployment
Lap #7 Dec 2010- this time my Colon was adhered to my abdominal wall
Since the start of our journey, new issues along with original Endo, 3 MFI unexplained, Cervical Stenosis, AMH .08, Low AFC, 2 blocked tubes
IVF #1 - ET 09/18-Transferred 2 Embryos
Beta #1 09/29-23 Beta #2 10/01- 52 Beta #3 10/05-342!! Lil Cub born 5/20
Re: HIPAA Q...Long, sorry!
I also had to do the pee test to confirm pregnancy after IVF with a civilian provider. I also had to take the class, which from my experience is a pretty standard thing that you'll find pretty much everywhere. It's really geared more to clueless parents-to-be who don't realize you shouldn't smoke or booze up during pregnancy, but there was some interesting/beneficial information in there as well. Every MTF has their own policies, which may or may not be identical to Tricare's, so calling them for procedural clarification about the way an MTF works is probably going to get you nowhere.
As far as HIPAA goes, every SQ has a few people designated that are considered "need to know", and those are the people who get the calls. The MDG is within it's rights to release your information to those people if they felt you were being abusive or uncooperative with the hospital staff and leadership needs to be involved. It doesn't matter if it's "your" info or not - your DH is your sponsor and as such, he is responsible for you and your behavior on base. Hence, the call to his leadership.
I am VERY surprised that this issue got all the way up to the CC of the MDG over a simple misunderstanding, some rudeness, and a desire on your part just not to take a class. I guess I'm not 100% clear on how this happened - did they schedule you and you just didn't show for the class, or did they not get to the scheduling part? Obviously, someone thought this was a significant enough issue for the CC of the MDG to take time from his/her incredibly busy day.
You sound like you'd be a great candidate for Tricare Standard, if that's an option in your location. Or, get yourself onto private insurance so you don't have to mess with Tricare at all.
Otherwise, just take the class. It's the first of many pointless appointments you will have in the middle of the day, trust me.
That's exactly what I was afraid of, basically I don't have any HIPAA rights. They had not scheduled me for any class. What I think tipped them off was I asked what happens if I don't take it.
I can't afford to take off another day of work for a class that the base commander has mandated. It's ridiculous.
I have my referral, it's not like they can take it away at this point.
I think my biggest peeve is that they can be as rude as they want to me, and I can't do a thing about it. The one thing about using the MTF- they do not have to answer to anyone for their actions. They get to act as they choose and be rude and no one cares. Or the fact that everyone gets to talk about me, and since I can't exactly waltz into my H's commander's office, I don't get to defend myself.
I am so frustrated that Tricare is allowed to do this. I think I may end up going back to using my work's insurance so that I can do whatever I want. It will be much easier for me.
Thanks for the clarification, that's really what I thought about the HIPAA. I feel like property of the DOD with zero privacy.
IUI#1-April 2010- Clomid 100mg, Ovidrel and timed intercourse= BFN
IUI #2- Cancelled due to cysts
IUI #3- June 2010- Clomid, Ovidrel and timed intercourse= BFN
Break due to DH deployment
Lap #7 Dec 2010- this time my Colon was adhered to my abdominal wall
Since the start of our journey, new issues along with original Endo, 3 MFI unexplained, Cervical Stenosis, AMH .08, Low AFC, 2 blocked tubes
IVF #1 - ET 09/18-Transferred 2 Embryos
Beta #1 09/29-23 Beta #2 10/01- 52 Beta #3 10/05-342!! Lil Cub born 5/20
Well, it's not so much that you don't have any rights, but that this particular example is probably not enough of a violation to make it worth raising hell over. I get that it's annoying and makes you feel violated, but, really, it's not as though they publicized your social security number and perused your credit report, or went to lunch specifically to discuss the annoying spouse.
Someone with need to know called someone else in the chain with need to know and divulged that you're pregnant in the course of a discussion about MTF policy. Big picture legally, it just isn't that much of a thang.
I think you've got the right idea switching off Tricare altogether. It sounds like you'll be much happier. GL!
Married 11/27/09 and TTC right away
Dx: Complete septate uterus with cervical duplication, endometrial polyps, PCOS, endometriosis, hypo thyroid, luteal phase defect
4 uterus surgeries to correct my complete septum and to remove polyps and 2 years of seeing the RE, medicated cycles and IUIs
Baby 1 and 2: BFP 3/3/11 with 2 babies EDD 11/1/11, M/C 4/6/11
Baby #3: 8/11 pregnant EDD 4/27/11 and m/c:(
Baby #4: 10/12/11 BFP! EDD 6/16/12m/c 10/26/11
Baby #5: 3/13/12 BFP! EDD 11/25/12 ANOTHER m/c
Baby #6: 2/14/13- BFP! EDD 10/24/13, CP 2/19/13
Baby #7: 3/15/13- BFP! EDD 11/27/13, another CP
Baby #8. BFP 5/19/13 EDD 1/22/14. 8 was not our lucky number
4th septum resection on 5/31/13.
Baby #9: 6/29/13 BFP. C section scheduled for March 5th!
My miracle baby was born March 5 at 9:33am. He was 8 lbs 12.5 oz and 21.25 inches long!
Yeah we must be a different branch, too, because there was no class. There was also no mandatory anything for appointments. Obviously I went along with the suggested schedule, but I declined all kinds of stuff along the way. I eventually did raise a little bit of a stink and went off post, but that's a different thing altogether.
And need to know would be like another doctor involved in your care, not your husband's command ... that's really sketchy to me. I guess like a pp mentioned it could be because you were making too much of a fuss on post, but still ... I don't know about that ...
This doesn't sound like tricare issues either. It sounds like your MTF. So maybe you should switch to standard (if it's cheaper than through your work, which I think it probably would be with global maternity). And I would talk to the advocate if I were you. I know a lot of ladies who have gotten really great results by being persistent with their advocates.
This sounds like it all really sucks. Good luck. I hope you get better care soon.
My H is a physician at an MTF and recently experienced a HIPPA violation himself that had to be elevated to the hospital's compliance officer, which is a roundabout way of saying that no, your medical information is not less private simply because of your husband's job. Particularly since you hadn't actually declined the class or no-showed I think you have a legitimate complaint on your hands. H is dead to the world right now, but when he wakes up I'm going to read this post to him and let you know what he suggests.
H says that it's a clear HIPAA violation--your H's supervisor has no business knowing anything about your medical information. He also recommends going to the patient advocate. I know you're skeptical that they will do anything, but it's where you need to start. If they don't take your complaint seriously then you can start elevating it. After that I heartily recommend switching to Standard so you don't have to deal with that clinic anymore.
As a fellow IF survivor, congratulations on your pregnancy!
OP- What you wrote here is 100% incorrect. I am AD in military healthcare and can assure you that you do have total right to privacy under HIPPA.
It's not like your H's Chain of Command will never know that you're pregnant. It really sounds to me like you did not follow MTF policy and your H was being informed about this through his First Shirt. Oh well!
I agree with the PP, who stated this is not that big a deal. Go into your MTF and find out exactly what you are required to do and do it. TRICARE is one of the best healthcare benefits companies in the country! I take it you've never had to deal with other health insurance companies. I can assure you that you are very lucky to have the coverage you have.
1) Total violation of HIPAA. Call the MTF CO's office. There is normally a secretary or assistant who answers who can direct you the "patient coordinator" or some similar title who will handle any complaints.
2) For us, with the Navy, there was a class I had to attend. The main goal of it was to fill out your paperwork and be introduced to the staff, their policies, pregnancy, etc. It only lasted about 2 hours, and was mandatory for everyone, whether it was your first pregnancy or your 100th. It was where they made sure everyone got set up for the first appointments and bloodwork, etc. I know a few ladies who got out of it because of their work schedules, but you will have to push for that with the clinic. It has NO bearing on your Tricare benefits, but more it's a matter of ease for them to streamline the registration process for their new patients. Call TRICARE direct, ensure that you have a referral in to OB, and you're set on their end.
3) I agree partially that it's not too bad in the grand scheme of things (your husbands command would have found out sooner or later, and them knowing might help in case you end up on bedrest or something and he needs special liberty), but at the same time, if the clinic is this lax about this, what else are they doing wrong?
I am a military medical group member with HIPPA and Privacy Act training. Yes, your rights were absolutely violated and there is no way they can require you take any class to be covered on insurance. I was offered the class, but not required to take it. I was happy to get a few hours out of the office.
The military can NOT do whatever they want and are responsible for their actions. There are higher powers that we MUST answer to and customer service is still a concern in military facilities. Contact the patient advocate as soon as possible and if you are not comfortable with that, go to the Inspector General. Just because this is a military facility and you are affiliated with the military does not mean that they can walk all over you. Your information was protected health information and it was leaked. We cannot even tell someone's supervisor anything about their medical condition(much less their wife's). We can only say things like when they have an appointment and if they are currently at their appointment, and if they have a medical condition that makes them not world wide qualified. Again, go to the Patient Advocate or Inspector General. You need to do this so that this facility can be better trained and not do this to someone else. The pictures and names of the Patient Advocates should be posted somewhere in the facility, usually by the front desk of whichever department you are in.
https://www.tricare.mil/mybenefit/home/Medical/RecordsAndPrivacy/HIPAAPrivacy
This information is directly from the Tricare Website:
Who must comply with HIPAA?
All military and civilian health care plans, health care clearinghouses and health care providers who electronically conduct certain financial and administrative transactions must comply with HIPAA. TRICARE, military treatment facilities, providers, regional contractors, subcontractors and other business associate relationships fall within these categories.
How the Privacy Rule Protects You
The HIPAA Privacy Rule lets medical staff use and disclose your protected health information for treatment, payment and health care operations without written authorization. Your permission is required for most other uses and disclosures.
Under the Privacy Rule, you have the right to:
Each MTF has a privacy officer who ensures health care information remains private, but available to you and your provider. The privacy officer can answer any questions you may have about HIPAA rules. The TRICARE Management Activity (TMA) also has a privacy office you can contact for information or assistance. In addition, your regional contractor has valuable information about privacy on its Web site.