Hipaa

[Sef0912]

Does anyone know if it is considered a HIPAA violation for a Dr.'s office in the US to share your personal information with a pharmacy which you have not approved them to share the information, even if it is regarding helping you to get the medication you need (Especially when your own pharmacy that you have chosen to share this information with and have given the Dr. consent to contact and give your information can provide the medication?) Also, can they share you information with drug companies for medication pre-approval without your consent?

 

[afidz]

I don't think that is a HIPPA violation. I know that my health insurance company demands I use their pharmacy when I fill daily prescriptions. If you are trying to get pre approval for a drug, I think consent is implied.
But, maybe if I understood your situation a little better? What led up to you thinking there was a HIPPA violation?

 

[nogutsnoglory]

I have never had to fill out any hipaa paperwork regarding pharmacies but maybe some notice on that is included in the hipaa wording. Do you feel wronged?

 

[Sef0912]

I don't feel wronged by the pharmacy, as they were contacted by my Dr.'s office to fill a prescription, without my consent and without the Dr.'s office even letting me know that they were contacting another pharmacy to fill my prescription. The Dr.'s office gave this pharmacy all of personal information, including my social security number and birth date, which is PHI, without my consent, and this is where I feel wronged. They also authorized this pharmacy to bill my insurance and them to charge me for shipping of said medication, which is also where I feel wronged, as this medication was pre-approved by insurance to be filled at the pharmacy I use and have given consent to my Dr.'s office to contact. And, on top of that, I have not decided yet whether or not I am interested in starting said medication due to the Dr.'s office still not calling me back after almost a week of trying to contact them regarding questions I have about the medication and other items they have stated I needed before starting the medication. In the HIPPA wording from my Dr.'s office, regarding pharmacies and treatment, it states:
"Treatment - We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services.
This includes the coordination or management of your healthcare with a third party that is involved in your care and
treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will
also disclose PHI to other Healthcare Providers who may be involved in your care and treatment. " The problem I have is it says that it can disclose my information to the pharmacy, but in the top of their privacy policy it states they can only disclose my information to those who I approve of having it disclosed to, including medical providers and pharmacies of my choosing. I did not chose this pharmacy and frankly the Dr.'s office and insurance have provided me with a list of pre-approved pharmacies of my choosing for certain medications and I chose the ones that I approved, and they shared my information with one that I have never chosen or would never choose and elected for me that I was willing to pay this pharmacy and gave them my personal and billing information, not cool at all in my opinion and against this privacy policy in my opinion, although I may be really wrong. Sorry for the rambling, but it really makes me mad.

 

[nogutsnoglory]

I know doctors have called in medications for me that I didn't know about. Your situation is different, I am not sure what you should do to be honest but I can understand your aggravation.

 

[alex_chris]

In the HIPPA wording from my Dr.'s office, regarding pharmacies and treatment, it states:
"Treatment - We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services.
This includes the coordination or management of your healthcare with a third party that is involved in your care and
treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will
also disclose PHI to other Healthcare Providers who may be involved in your care and treatment. "

The problem I have is it says that it can disclose my information to the pharmacy, but in the top of their privacy policy it states they can only disclose my information to those who I approve of having it disclosed to, including medical providers and pharmacies of my choosing.

So to be clear, their own privacy policy clearly states in addition to what you quoted that any information is only providrd to third parties if you specifically approve of those? Do you have the exact wording? If so, then sure, this would be a clear HIPPA as well as contractual violation. The consequence under HIPPA can be a serious fine for your Dr.'s office.

Disclaimer: while I am an attorney licenced in NY, I am in no way an expert on healthcare law.

 

[Sef0912]

"You have the right to request a restriction of your PHI - This means you may ask us, in writing, not to use or disclose any part
of your protected health information for the purposes of treatment, payment or healthcare operations. If we agree to the
requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your
treatment. In certain cases, we may deny your request for a restriction. You will have the right to request, in writing, that we
restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf,
has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction." I filled out their form for limited patient authorization for disclosure of PHI which limited my PHI to only be released to me, my PCP, the pharmacy I chose, and to my colo-rectal surgeon, and my mother in emergency situations, and it was approved at my first appointment. This would mean that they have given my PHI to someone who I did not request it to be given to, AKA the other pharmacy and gave them my billing information. My understanding is that it is my personal information and unless I authorize them to give it to someone else with this form being filled out and approved, they can't.

I understand they can disclose info. to my insurance company for billing with this statement. "Payment - Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain
activities that your health insurance plan may undertake before it approves or pays for the healthcare services we
recommend for you such as, making a determination of eligibility or coverage for insurance benefits." I understand that they have to contact my insurance company for some medications to be pre-approved to prescribe using my insurance coverage. But no where does it say they can authorize someone else to bill me for a service I do not approve of or give them my information. It is such a gray area, but I am really upset with them.

 

[Sef0912]

I know doctors have called in medications for me that I didn't know about. Your situation is different, I am not sure what you should do to be honest but I can understand your aggravation.

They have called in medications that I have not known about before to my approved pharmacy and then notified me of this, which is okay in my opinion, as they have not shared any personal information with someone I did not approve. But this time they called it in to someone I didn't approve of, or even know about, and gave them my personal and billing information and authorized them to charge me without my approval or consent.

 

[alex_chris]

I would talk to the Dr.'s office, calmly explain what has taken place and ask them to refrain from doing these things in the future. If they don't apologize and say they will work on rectifying their internal compliance system, I would actually tell them that you may consider to file a complaint with the Office of Civil Rights (part of the US Health Department) and set out the violation of HIPPA.