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Re: The so-called "AHIMA paradox"
On Wed, 22 May 1996, Meg H. O'Donnell wrote:
Reality #3: It is exactly this kind of issue that motivates those of us
in the trenches who are trying to adopt statutory protections, on both the
state and federal levels.
Vermont's proposed health care information law, which was tabled at the
end of our recent legislative session after having been endorsed by three
of the four committees working on it, and having passed the House,
included strong language to the effect that even if an insurer has access
to medical records with a patient's written consent,
*access was restricted only to the minimum amount necessary to accomplish
the purpose for which it was released.
* This means an insurer who needs to pay a claim
* gets only what is necessary to pay that claim,
* and nothing more. This principle would have
applied to *any* release of information, and would penalize the
release or use of information in excess of that minimum.
S. 1360 has similar provisions.
> Meg H. O'Donnell
> General Counsel
> Vermont Health Care Authority
*Who* makes the decision as to WHAT is germane to the claim. It is one
thing if I have turned in a noncontestable claim for an injured wrist.
It is a far different thing if the claim is contestable and the insurance
company is looking for ALL health history from say 1984 to date of death
In the first case company needs only the data pertaining to the injured
wrist; in the second, the company needs all data from time(x) to time(y)
in order to decide whether they would have issued contract in first
instance and if so, on what terms.
Although it has been almost 20 years ago, I still recall medical
information released on the bare minimum. Policy was contestable on
health; some clerk typed some medical conclusions from chart as to WHY the
patient was in hospital AT PRESENT TIME, progress during stay, etc.
Basically it said patient was ill, was admitted, treated, improved and
discharged. Not one syllable was typed about patient's medical history
... the meat was buried in the chart notes, not history/physical, not
discharge summary, not doctors' orders, not .... Clerk was acting in good
faith but simply was neither trained nor qualified to evaluate what
information was germane to the contract at issue.
I said it before on another list and will repeat it here: easiest way to
handle the claim is to
1) REFRAIN from getting ANY medical records from the provider
2) have provider pay policy benefits out of ITS cash register
3) have provider submit records to insurance company to justify provider's
claim for reimbursement.
About time provider is digging into its pocket for a couple million
dollars on a policy a few months old, watch how much info it will submit
to get that $2,000,000 back.
QUESTION: Why could not a person waive a statutory edict provided waiver
was made willingly and intelligently? Why can I not decide parameters
about release of MY medical information.
I have repeatedly encountered claims where it was necessary to get ALL the
information. What training do the medical record custodians have to
enable them to properly evaluate whether all or some or none of the
information is germane to the CONTRACT language at issue? Their training
stops at whether to release the information. (And in a few case it stops
short of that ... and I have encountered problems with RRA's and ESQ's on
I really get nervous when some legislator attempts to take command control
over my information.
I agree with you improvement is needed. One law had a 30 day cap on time
authorization was valid. Who are you or anyone else to decide 30 days if
I elect 30 fortnights or thirty years. My medical chart shows the time
and date that I quit smoking. Should I choose, I could allow my doctor
carte blanch power to release THAT data to anyone at any time for any
reason. Why not? Is it not my information?
And I agree we should work to get GOOD legislation rather than mail bomb
James D Brady, Columbus, OH, typing for Jim and no other one or entity.