HIPAA & You

Protection for patients and their access to health care

Everyone knows the way traffic laws affect how and where they can drive, but few people understand how health care laws affect how and where they can seek medical treatment. HIPAA stands for Health Insurance Portability and Accountability Act, and it has been part of Federal law for almost fifteen years.

Like many laws, understanding each and every part of it would require reading hundreds of pages of documents. Here is our simplified summary of what it means to the average patient.

1. For patients that lose or change employer-provided health insurance

One primary goal of HIPAA is to limit the exclusion of care for pre-existing conditions that many health insurance plans have as a limitation to what they will cover. HIPAA put forward very specific criteria for how any loss or change in health insurance coverage would define a condition as pre-existing in order to allow individuals whose insurance coverage changed not to be excluded from coverage.

2. For the privacy of a patient's health-related information

Establishing a formal set of rules for what kind of patient information can be shared between a hospital, insurance plan, and other entity is another primary goal of HIPAA. Defining what is Protected Health Information (PHI) and the limits to who has access to it protects patient privacy. It also provides provisions for notifying a patient of when and with whom information may be shared. Recently, new provisions have been added that relate specifically to the security of and qualified access to information contained in electronic medical records.

Where we stand at SNE Primary Care

We believe that electronic medical records have great value to primary care medicine, because they enable us to spend more time with patients. We are able to get to know more about the details of their lives and wellness that enable us to more effectively improve their state of health. We fully (and gladly) comply with all mandates for the privacy of patient information.

We will only release medical information with your express authorization; your written consent is one of the forms you will need when you become an SNE Primary Care patient. By providing qualified referrals, we are usually able to ensure that additional care you receive is validated and accepted by your insurance coverage; however, it is your responsibility to know the details of your plan and the extent of your coverage for different treatment options.