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I used the word "subscriber" because that is the verbage used by the Dept. of H&HS. I don't mean it like subscribing to a magazine. I think it has a slightly different meaning when applied to this issue.

But HIPAA subscribership aside, isn't the real question whether the HCP in question has done anything wrong? They haven't denied access to the records: Mw99 can look at them anytime he wants. The HCP have simply chosen to limit access which is allowed under the conditions I stated earlier. Yes, it may be a stretch but it is not out of the realm of possibility to apply any one of the three conditions in an effort to limit access.
And again, under the law, Mw99 can challenge the application of limitation any time.
But so far, nothing illegal has occured here.

Why not go in there w/ a digicam and surreptitiously snap a few shots? Unless of course ya have an eidetic memory Mw99.

All those places DO have one thing in common!! !! !! They do NOT get paid by, on behalf of, the subject, for it, and the info is used to JUDGE the subject! Until a couple decades ago, the credit report distribution was the SAME WAY! Of course, they EVENTUALLY CHANGED credit reporting so that the people that do NOT get paid by the subject, where the info is used to JUDGE the subject, MUST tell the subject WHAT, in general, they used to determine it, and WHERE to get the info, and that the agencies, that would ALREADY give the info to the subject, MUST give it to the subject for FREE at least once a year.

ALL doctors and hospitals DO get paid by, on behalf of, the subject, for it!! !! !! !! !

My comparison is ESPECIALLY interesting, because I am comparing two sets of information that are BOTH protected by privacy laws, and often received by the same, or similar people for the same reason. ONE to determine how likely you are to pay your bills, and one to determine how likely you are to remain healthy(or ABLE to pay your bills).

In short, your argument is like saying that stores don't have to tell the truth about what you get in something they are trying to sell, because others don't have to tell the truth about that item that they bought. It just isn't the same thing.

BTW you didn't go to the next level:

Requests from your employer

The Privacy Rule does not prevent your supervisor, human resources worker or others from asking you for a doctor’s note or other information about your health if your employer needs the information to administer sick leave, workers’ compensation, wellness programs, or health insurance.

However, if your employer asks your health care provider directly for information about you, your provider cannot disclose the information in response without your authorization.


Covered health care providers must have your authorization to disclose this information to your employer, unless other laws require them to disclose it.



Generally, the Privacy Rule applies to disclosures made by your health care provider, not to the questions of [others, such as] your employer.

For further information on this topic, please refer to 45 C.F.R. §§ 160.103 and 164.512(b)(1)(v), and OCR’s Frequently Asked Questions.

End quote

Still, I would say that punitive or negligent use of, release of, info from your employer CAN subject them to legal problems, etc.... Such problems HAVE happened before. ALSO, if they let you go, or you found you weern't hired, because of non material info in the report, they can be in trouble. HECK, the ADA codified that. Even some MATERIAL info may not be usable against you!

I tried to get back OT but somehow the fray keeps going back to issues of payment which is not germain to the issue of whether Mw99s' prior HCP is doing anything wrong by limiting access to his PHI. Based on the sources I've already cited, I would say no. This is not that same thing as my agreeing with the limitation. I'm just saying there is a "loop-hole" of sorts the HCP may be exploiting.
I'm just saying that it's not as easy as waltzing into your doctors' office and demanding your records. In this case, where the mental state of the client may be of concern to the HCP in question it is incredibly prudent for the HCP to exercise extreme caution when providing PHI.

I believe you do have a legal right to a copy of your records. If the psychologist deliberately refuses, I would like in to reporting this to the state licensing board.

But the HCP is ******NOTHING****** like the examples you cited. HECK, you DID say HCP! I ASSUME you mean Health Care Provider. The examples you listed have NOTHING to do with providing health care AT ALL unless you want to try to squeeze through on a small SIMILARITY or rather TIE that gets us back to where you just said you DIDN'T want to go. Insurance DOES provide partial payment for the services! THEN AGAIN, TECHNICALLY, they are usually, in the US, FORBIDDEN from getting the records that you speak about! They generally want, need, and request, records from prior insurance companies. THAT is because they MUST pay for those, and may not have to pay for other existing conditions. For new results, they may simply get summaries, as the diagnosis and method of treatment are the only things germane.

The ONLY relevance this may have to a persons mental health is how they might react. Such a reaction will be the SAME whether they have it on paper, or simply in their head. BTW I got info from my doctor EVERY time I asked. I even once got a writeup on a major and complex operation I had. Although it didn't have some detail I wanted, it was several pages long, and DID cover a lot of detail. I WAS surprised when the hospital failed to give me info on some tests, that I was REQUIRED by everything around to have(failure to release could have been tantamount to murder), but the DOCTOR DID! Oh well, I prepared to do THOSE tests myself, and now *I* tell the hospital!(Simply to show compliance, and get perscriptions I need) Anyway, I worked up a big surplus, just in case they DO pull any tricks.

HECK, I once discussed some differences on a blood workup with a doctor. I knew 2 were related to a valve I have, and he said that was correct. The third was due to another drug I am taking.

Go into his office and demand a copy of your records!

I'll be honest, I understand literally NONE of the above post.


Yes, for the most part this is true. There are exceptions however.

As has been previously stated, it's not quite that simple. Most requests for PHI must be made in writing. The HCP has up to 60 days to furnish copies of the pertinent information (or a "Summary").

Now this brings up an interesting question. Now I'm guessing you believe this loophole within HIPAA regarding whether to release or allow a patient to view his/her own file is up to the HCP depending on whether information in the file is potentially damaging in some way to the patient. Please correct me if I'm wrong.

Now if the patient is an adult, isn't that no longer a concern of the provider? Unless the client is a ward of the court or under someone else's guardianship, the HCP does not have the right to deny records to a client or former client if that person is an adult with full rights? I'm admitting in this case that MW99 has access, and I'm going to assume he can copy the file (he should ask when he goes in). Unless the provider can show in a court of law the client would be harmed by the information in the files, he has no recourse but allow the files to be viewed?

So unless MW99 has mental health issues that have been before a court, this HCP has no legal reason to deny him/her the right to his/her files? This is in theory, because actually the provider has told MW99 s/he can access the files.

Just something I was wondering...this actually is quite interesting.

Thank you all for some intriquing thoughts.

n/m

Last edited by Mw99 on 03 Feb 2009, 8:25 pm, edited 1 time in total.

Actually, this is incorrect. Section 164.524 (Access of individuals to protected health information) of HIPAA very clearly spells out the limitations on an individual's rights to their protected health information (PHI). In particular, paragraph (a)(3) spells this out very clearly. The good news for you, Mw99, is that paragraph (a)(4) states that you have the right to have their decision reviewed by another licensed healthcare provider (that they appoint as the "reviewing official"). You can find the full text of the law here (just search on "164.524" to get to the relevant section). The APA has an article that spells out how the psychological community views this section. You can find that here.

For what it is worth, I am quite well versed in HIPAA, since I have worked for over 16 years building software for the healthcare industry (and, yes, I've been "trained" multiple times, but, IMO, HIPAA training is usually pretty minimal). I won't put myself out there as an expert, but the law is pretty clear on this point. You are definitely right that the spirit of the law supports your right to access, but still allows your provider (the "covered entity") to exercise their professional judgment. My suggestion is to approach your provider with the assumption that they have valid reasons for their decision. Explain your concerns, and ask whether there is a subset of the record that would be appropriate for you to have a copy of (session notes or notes that they gathered from other individuals may be what they are concerned about). Since they are willing to let you view your records in their office, I don't get the sense they are trying to hide anything from you. If you run into resistance, politely asking about exercising your rights under paragraph (a)(3)/(a)(4) may be an appropriate next step. Again, assuming that they have reasons for their decision will probably help here, as will knowing that you do have clear and specific rights, and that they should explain the reasons for their decision to you.

Best of luck!

Oh. One other thing. Your provider is almost certainly covered by HIPAA (unless they don't accept insurance at all). An outright refusal to provide you with a copy without citing a reason may simply be a holdover from old school attitudes towards medical record access. I basically have no comprehensive medical record as a result of this pre-HIPAA mentality since I have moved many times over the years. If you run into this, you may want to look into having a pro-bono lawyer at a civil rights organization "encourage" your provider to comply with the law. As I said before, best of luck!

Just a thought, ask them to put their refusal in writing (if they haven't already). If they are on legally shakey ground, my guess is they won't want to do this. If they are (or think they are) on solid ground, it shouldn't be a problem for them to do this.

It's weird they'll let you look at it, but not have a copy. If you have it in you to keep fighting for this, I say don't let it go.

There are places in the UK (Citizens' Advice Bureau) that offer free advice in all sorts of matters. I don't know if there are similar institutions in the US, but maybe something like that could be of help. There maybe patient groups who will advocate for you in these sort of situations. Have a dig around and see what support is out there for you.

Good luck!

n/m

Last edited by Mw99 on 03 Feb 2009, 8:25 pm, edited 1 time in total.

It might suggest they are not entirely within their rights to refuse your request. I think it is very reasonable thing to ask for. If they do refuse, it might be a clue that you have a case.

I would find some external, independent help if you want to pursue it. Find out for sure what your position is. If you are in the right, what to do then? I would say don't "go away". If it matters enough to you, be persistant, don't let them fob you off, but make sure it's all done in a very polite, business-like way and you keep records of any letters you might send, or the phone calls that you make.