Confidentiality, Privacy and Security

Billing Minor's Confidential Visits

  • 1.  Billing Minor's Confidential Visits

    Posted 06-28-2019 10:17

    When you have a minor who is seeking diagnosis and/or treatment for a condition in which they do not need consent from their parents, such as STI's or pregnancy, what is to be done with the bill if they have requested confidentiality? It is assumed that when you bill the insurance that the parent or guardian will see the visit on the EOB. We have a protocol in place so that the confidential record is kept separate from the minor patients other record but I would like to know how to handle these situations in a HIPAA compliant manner and am curious as to how others are handling this.



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    Misty Zink
    Compliance Officer/Him Director
    Big Horn Hospital Association
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  • 2.  RE: Billing Minor's Confidential Visits

    Posted 07-01-2019 08:41
    Actually, I think this is something that the provider or another representative needs to discuss with the minor prior to the visit.   If the minor is willing to pay for the visit, than there is really no issue - but that is rare.   Realistically, I think someone needs to inform the minor that if he or she plans on the parent's insurance covering the visit, they need to know that a statement will be sent to the parents.   This is why we encourage using local family planning clinics which may operate under different regulations.   It has been my experience in the state of Wisconsin that even if a minor can consent to his or her own care for certain conditions - in most cases the parents would have access to the health records.

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    Nancy Davis, MS, RHIA, CHPS
    Director of Compliance & Safety
    Door County Medical Center
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  • 3.  RE: Billing Minor's Confidential Visits

    Posted 07-01-2019 17:34
    Hi Nancy,

    In the State of Montana, a minor patient has the right to control access to their health information as well as consent to treatment under certain criteria. Pregnancy, communicable diseases, and STI's are a few of these under our MCA. And under HIPAA, one exception to parents/personal representatives having access to the minor child's records is "When the minor is the one who consents to care and the consent of the parent is not required under State or other applicable law;". As you can probably imagine, it puts us in a bit of a spot.

    227-Does the HIPAA Privacy Rule allow parents the right to see their children's medical records

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    Misty Zink
    Compliance Officer/Him Director
    Big Horn Hospital Association
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  • 4.  RE: Billing Minor's Confidential Visits

    Posted 07-03-2019 15:55
    Hi There,

    In the state of NY we mark visits like the ones mention above as confidential.  When this occurs, no bill is sent to the insurance company​, hence no EOB sent to the parents insurance.  I don't believe the hospital makes the patient responsible for the services, it becomes a write off.

    Thanks,

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    Sherri Turner-Burton
    Director of Him/Hipaa Privacy Officer
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  • 5.  RE: Billing Minor's Confidential Visits

    Posted 07-03-2019 18:34
    Hi Sherri,

    We create a separate confidential record in these situations and were thinking of handling them, bill wise, in a similar manner.

    Thanks for your response.

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    Misty Zink
    Compliance Officer/Him Director
    Big Horn Hospital Association
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  • 6.  RE: Billing Minor's Confidential Visits

    Posted 07-08-2019 14:39
    Hi Misty,

    Do you use paper records for the confidential visits?  Our system is hybrid and based on the service, if we document electronically it goes with the record for all the appropriate providers to see but a bill does not drop.  It is so interesting how we all can have the same issue but handle it in different ways :)


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    Sherri Turner-Burton
    Director of Him/Hipaa Privacy Officer
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