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Self-Insured, Self-Admistered Public Organization
Oct 12, 2012

I recently started a new position with a school district which is self-insured and self-funded. Although school board policy states that people with HIV have a right to employment, I do not feel comfortable submitting claims for clinic visits and labs. The claims specialists told me that they do not get health information about employees from the perscription drugs they order. They have a third party administrator of drug claims and they are given the monetary amounts. They said, however, that if employees wanted to get reimbursed for co-pays through flex spending, then they will get employee health information given that they will have to have receipts for the drugs.

Is this fairly typical that employers don't know medical information based on drugs ordered?

I am simply terrified to submit a claim for a lab or clinic visit.

Response from Mr. Chambers

Self-insured health plans are scary for people concerned about medical confidentiality. Usually, an employer large enough to be self-funded is well aware of the dangers of using medical information in personnel decisions so they are careful not to get details of medical conditions other than amounts spent on claims. They hire third party administrators to process claims and make sure they have no direct access to the employees' medical history.

I'm surprised they don't hire an outside administrator to handle the flex-plan claims as well, since it raises the same breach of confidentiality potential as self-funded health plans.

Look into what information the flex-plan requires for reimbursement. I doubt that it requires any information about the details of the charge beyond whether it was a doctor's visit, lab test, etc. without detailing why it was done. As for drugs, it should only be requiring a paid receipt and prescription number without naming the drug.

Honestly, if your employer is large enough to be self-funded they don't have the capability to scour claims of all employees and they almost always are aware of the legal liability they are incurring if they dig too far into employees' medical bills.

Good luck, Jacques



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