Confidentiality, Privacy and Security

Family Planning/Billing

  • 1.  Family Planning/Billing

    Posted 03-29-2019 15:06
    ​We had a patient who came in for family planning services. We do not bill for the family planning services and the patient was marked as a confidential patient. Unfortunately, the visit was billed to her insurance. We contacted the insurance and explanted it should have not been billed. Does submitting that claim to the insurance company make this a HIPAA violation/breach?

    Jessica Moody
    Health Information Manager


  • 2.  RE: Family Planning/Billing

    Posted 03-29-2019 16:27
    This is a complicated scenario but in essence yes it was a breach of restricted information.

    Below is a link to help guide you through this process  

    Since its initial adoption, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule has granted individuals the right to request restrictions regarding the use and disclosure of their protected health information (PHI) for treatment, payment, and healthcare operations (TPO). The law also grants individuals the right to request restrictions for other disclosures, such as those made to family members. It is up to the covered entities (CEs) to determine whether or not to accept or deny such restriction requests. When the CE agrees to the restriction, the CE must adhere to the restriction for all future disclosures except in the event of an emergency. If the restricted PHI is disclosed to another entity or person for emergency treatment, the CE is required to request that the person or entity receiving the information not further use or disclose this PHI in any manner.

    The HITECH-HIPAA Omnibus Rule, effective September 23, 2013, takes request for restrictions one step further, and requires that "a covered entity must agree to the request of an individual to restrict disclosure of protected health information about the individual to a health plan if the disclosure is for the purposes of carrying out payment or health care operations and not otherwise required by law; and the protected health information pertains solely to a health care item or service for which the individual, or person other than the health plan on behalf of the individual, has paid the covered entity in full."

    Thanks Kris

    Kris Lundell MBA,  CIPP/US, CHP
    Privacy and Security Consultants LLC

  • 3.  RE: Family Planning/Billing

    Posted 03-31-2019 10:15
    ​Hi Jessica,

    If you are marking the chart Confidential because the patient is a minor and the minor is protected under Minor Confidentiality Regulations, submitting for billing does not automatically constitute a breach.  It is a breach of confidential PHI if the patient's parents are notified.  There are some insurance companies that do not send EOBs to the policyholders.  (In Colorado, Medicaid does not send EOBs so we will submit for billing) If the EOB is not mailed to the parent policyholder, it does not notify the patient's parents.  Now, if the EOB is sent to the parent policyholder and they read it and confront the minor, you have breached their right to confidentiality as a minor seeking services for family planning.

    Now if you are referring to an adult and you have agreed to an Exception as outlined CFR 164.522 Patient's Right to Request Restrictions and they have ask to restrict their insurance company for that visit, I would agree that it is a breach.





    Elaena Price
    Operations Manager/Health Information Manager
    HIPAA Compliance Officer
    Mountain Family Health Centers

  • 4.  RE: Family Planning/Billing

    Posted 04-01-2019 08:24
    Honestly, I don't know if the patient's parents were notified. We are located in Tennessee and I get EOBs every time my insurance is filed. ​

    Jessica Moody
    Health Information Manager
    Hamilton County Health Department

  • 5.  RE: Family Planning/Billing

    Posted 08-20-2020 23:20
    If the  facility does not normally bill for family planning services, then why was the insurance billed for the services?

    Trina Collins