Column 42 Surprise!

Surprise!  Covered California has apparently just found out about HIPAA (Health

Insurance Portability and Accountability Act of 1996").  As of last week, when calling to find out about our clients status and account, we were informed that they could not discuss the case unless we were on the file as "authorized representative".  Interestingly, when we first set up these accounts for our clients, there was discussion if we should or should not complete that section and we were advised it was not necessary.

Since the inception of this program I have been intrigued by the fact that the normal protocols of insurance underwriting had not been included in the process.  So, now they will not talk to me or my assistants without each of us included in this status on this account. So, we will now have to go into each client's record and make that change.  All of us who have enrolled multiple accounts are delighted for some additional work on these accounts that have already been an administrative challenge. We will all be hopeful that the system will be operational for us to make this change.  So in the interim, if your agent has been unable to assist you with Covered CA, please understand that this is why. 

Our office will likely contact our clients to advise them of this situation before we proceed and request a negative election from them.  But with deadlines of 4/15 pending this does present one more challenge.

So what is HIPAA?  This law as the name implies covers many issues, but for this discussion, it is primarily about the individual's right to have their information kept private and only disclosed under certain circumstances. In the past when applicants were subject to medical underwriting, we were required to the medical history questions were comprehensive and covered the last 10 year's medical history.  Detailed records were often provided to determine if the individual were an acceptable risk. 

Under the ACA (Affordable Care Act) there is no medical underwriting, so health information is not required.  Covered CA however does ask for identifying information such as social security numbers and documentation for identification, as well as income information and documentation of this.  So it stands to reason that the applicant should have an expectation of privacy.  In fact, when the application is completed this is clearly stated and agreed to by the parties. 

Agents will have to give serious consideration as to how much involvement they can have with Covered CA after the initial enrollment. As this is the first year, we are doing everything we can to help our clients.  But I am also working to empower them to have control and responsibility for this part of the transaction.  Simply stated, if an individual is grated a subsidy ( and most are thousands of dollars per year) it seems reasonable to expect them to manage that part of the transaction themselves.  The agent can deal with the insurer and assist them with claims issues or choice of plan which has been our value all along.

So, why all of a sudden is this required? 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Information provided in this column is "to the best of my knowledge based on press deadline. Submit your questions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to be answered in the paper.