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Insurance telling employers
Oct 22, 2001

I have been afraid of going to a doctor and getting a complete physical annually, because I know already that I am HIV and HEP/B. My fear is that the doctor will have to disclose all details to my health insurance company and I fear that my insurance company will somehow relay my health risk to my Human Resource department. Does the health insurance company disclose health information to the company's benifit department? If that is the case can you recommend a responsible doctor where I can pay out of my own pocket for a complete health exam without having it to be disclosed to any organization?

Response from Ms. Franzoi

If your health plan is a fully insured plan, it is unlikely that the Benefits Department will have access to this information. However, if your plan is self-insured, the Benefits Department will have more access to medical claims. In the event that the Benefits Department does have access to information, they are required to keep this information confidential. Sharing this information with others in the organization cannot be done. Insurance companies and third party health plan administrators are in the process of developing controls within their organizations as they must comply with the privacy regulations under HIPAA by April, 2003.

I think the first thing you should do is determine whether your employer's plan is insured or self-insured. If it is self-insured, the insurance company will keep the nature of your illness confidential. If it is self-insured, there is the possibility that the Benefits Department (that is, certain individuals in the department) will have access to information which could make them aware of your health status. However, the Benefit Deparment isn't looking at the results of annual physicals to determine someone's health status. The information they are typically looking at is high volume claims and the diseases associated with them. This information is utilized in plan design and cost containment efforts - such as disease management programs, negotiated discounts with different facilities, formularies for prescription drug programs, etc.

It is difficult for me to refer you to a doctor without knowing your location. Even if I knew your location, this could be difficult. If there are clinics in your area that specialize in treatment for people with HIV-related illnesses, I suggest you contact them for a referral.



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