HIPPA and cancer

HIPPA stands for the Health Insurance Portability and Accountability Act and became law in 1996. This law protects your health information that is directly linked to you by your name, address, social security number, insurance identification number, etc. It gave physicians, hospitals, nurses and healthcare practitioners time to comply with the law.

At physicians’ offices and hospitals, registration usually includes a form about your health privacy that you should read and approve. Your permission on this HIPAA form allows healthcare professionals to send your health records to family members that you list (such as spouse, older children, and/or parents), your health specialists that you list, and the hospital if you are admitted.1

What is health privacy? Why should I care?

Understanding health privacy laws is important because your health records written by your healthcare practitioners (doctors, nurses, pharmacist), hospitals, and nursing homes must be kept private but also accessible in case someone needs to look up whether you are allergic to any drugs.

In contrast, your health records should not be given to people who do not need to know your health issues. For example, your health information cannot be given to employers or prospective employers without you first approving it.

Your health information cannot be sold to advertising agents so that other companies can specifically send you advertising brochures for products related to your disease.

Who must safeguard your health information?

Three groups of business must safeguard your health information:1

Healthcare practitioners: clinics, chiropractors, dentists, doctors, eye doctors, nurses, nursing homes, optometrists, pharmacies, psychologists, psychiatrists, medical laboratory testing facilities, and any healthcare providers who observe, analyze, and often write your health information.

Healthcare companies: Health insurance companies, health plans, employer-associated health plans, health insurance companies, HMOs, Medicare, Medicaid, military and veteran health care programs need to know which treatment was provided before they pay the bills.

Processors for healthcare bills: Private health information also can be transmitted to companies that actually process the visit, such as medical billing companies.

How does HIPPA help cancer patients?

HIPPA helps families coping with cancer diagnosis and treatment in five ways:2

First, HIPPA ensures that you the patient can read and review your medical records. Patients can also obtain copies of their medical records.

Second, many people obtain health insurance through their employers. If a person were to lose their job, the loss of the employer–subsidized health insurance is a major hardship for a family dealing with cancer. HIPPA provides the first set of protections to ensure families coping with cancer could maintain health insurance coverage.

People who lose their jobs that provided health insurance could remain in the employer’s group plan for at least 18 months if they paid the full monthly premium. This feature, called COBRA, helps many families keep health care insurance while they looked for another job. Because the employer is not paying for the insurance coverage of the laid-off employee, the laid-off person is paying more than the amount deducted from their previous paychecks.

People should keep record of their health insurance coverage including any COBRA payments. Records that show the duration of health insurance coverage can help them avoid a waiting period (or reduce it) for the next insurance plan.

Third, HIPPA limits exclusion of health insurance coverage due to pre-existing condition in group and employer health insurance policy.

Under the HIPPA law, a pre-existing condition is defined as a personal illness or health condition which required medical observation or treatment within the last 6 months. In other words, did you go to a doctor about it or receive treatment for it within the last 6 months?

Group health insurance plans that started before Jan 2010 can deny coverage for pre-existing conditions for only 12 months. If you maintained documented health insurance coverage for 12 months or more but then lost coverage for less than 63 days, the grandfathered insurance policy needs to cover your pre-existing condition.2 Note that you need to enroll as soon as you’re eligible for the group health insurance coverage.

Fourth, HIPPA does not allow group health plans and issuers to exclude or delay health insurance coverage to potential employees based on current or previous health status. If you found a new job that provides health insurance coverage, then they have to provide you the option to enroll in the coverage like any other new employee.

The Affordable Care Act allows a maximum delay of 90 days in group health insurance coverage by businesses. Note that businesses are NOT required to provide group health insurance.

Fifth, HIPPA does not allow group health plans and issuers to charge individuals with cancer a higher premium than the people in the current group. Thus, the premiums for an individual in a group policy cannot increase due to their previous or current cancer diagnosis. However, insurers can raise the premiums for everyone who is covered in the group plan.

The Affordable Care Act (ACA) and cancer

The Affordable Care Act instructs insurance companies to make at least some plans available for people with pre-existing conditions, like cancer. Thus, people with cancer or another health condition can obtain individual health insurance coverage. The ACA does not set limits on the rates.

The Affordable Care Act removed the lifetime limit on health insurance coverage for an individual. Thus, the patient and their family must weigh the treatment options—the risks to your health and quality of life vs the potential benefits. It’s important to ask the expected benefit and quality of life during and after the treatment: If the treatment extends life by a month but that month is loaded with nausea, vomiting, brain fog, severe pain, etc, and the chance for a cure or stable disease is less than 5%, then the individual needs to decide for themselves.

Thus, the HIPPA and ACA help families that are coping with a cancer diagnosis and treatment schedule.

---

Selected references:

  1. US Dept. of Health & Human Services. Health Information Privacy, acc.: April 16 (2015).
  2. American Cancer Society. 2013. What is HIPPA, acc.: Apr. 17 (2015).