Advertisement
The Body: The Complete HIV/AIDS Resource
Follow Us Follow Us on Facebook Follow Us on Twitter Download Our App
Professionals >> Visit The Body PROThe Body en Espanol
Read Now: Expert Opinions on HIV Cure Research
   
Ask the Experts About

Workplace and Insurance IssuesWorkplace and Insurance Issues
           
Rollover images to visit our other forums!
Recent AnswersAsk a Question
  
  • Email Email
  • Glossary Glossary


Third party Administrator confidentiality
Jul 24, 2012

If I send the medical question insurance form to the third party administrator, are they prohibited from sharing that information with employer? Are they bound by the same confidentiality laws as insurace company's.

Response from Mr. Chambers

Third party administrators are NOT subject to the same HIPAA medical confidentiality requirements as are "covered entities" under the Code of Federal Regulations "CFR" Title 45, 160.103.

It is my understanding (as a non-attorney) that an employer who self-funds its health plan and hires an outside administrator to process the claims, still retains ownership of all the documentation its contractor (the third party administrator) uses to perform its duties.

However, self-funded plans tend to exist almost exclusively with large employers whose "spread of risk" is sufficient that they don't need to "insure" for loss, but simply need someone to pay claims accurately. Employers that size tend to be well aware of medical confidentiality laws as well as potential discrimination in the workplace for even having such information.

Therefore, most of the employers (and their attorneys) build very strong "walls" so that specific medical information on employees and their families is not available to anyone in the company. This is done to protect themselves from any liability for misuse more than it is to protect employees, but it accomplishes the same purpose.

While I don't know of anything legal "prohibition" against such sharing, the sharing is extremely rare if not totally avoided.

Jacques



Previous
insurance in usa for international student
Next
can HIV

  
  • Email Email
  • Glossary Glossary

 Get Email Notifications When This Forum Updates or Subscribe With RSS


 
Advertisement



Q&A TERMS OF USE

This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.

Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.

Review our complete terms of use and copyright notice.

Powered by ExpertViewpoint

Advertisement