A retail scenario for pharmacy students

[BenJammin]

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You are a floater working for a chain. It is late in the afternoon and a 25 year old man comes to the pharmacy. He drops off two prescriptions: doxycycline for an infection and lortab for a broken leg. He makes the comment that he cannot afford cash prices for any of these drugs so he hands you his insurance card. Upon receiving his insurance information, you find out that he is still on his parent's insurance coverage due to Obama's health care reform (which will cover him until he's 26). You begin to enter the scripts when a note pops up from another pharmacist. It says "parents of patient have requested that we do not fill pain medications for their son, reason unspecified". You call the manager and they tell you to do what you think is right.

What do you do? Do you refuse to fill the lortab but dispense the doxy? Do you go ahead and fill it while billing it on insurance? Remember that he cannot afford the cash price for either script.

 

[ancienbon]

You are a floater working for a chain. It is late in the afternoon and a 25 year old man comes to the pharmacy. He drops off two prescriptions: doxycycline for an infection and lortab for a broken leg. He makes the comment that he cannot afford cash prices for any of these drugs so he hands you his insurance card. Upon receiving his insurance information, you find out that he is still on his parent's insurance coverage due to Obama's health care reform (which will cover him until he's 26). You begin to enter the scripts when a note pops up from another pharmacist. It says "parents of patient have requested that we do not fill pain medications for their son, reason unspecified". You call the manager and they tell you to do what you think is right.

What do you do? Do you refuse to fill the lortab but dispense the doxy? Do you go ahead and fill it while billing it on insurance? Remember that he cannot afford the cash price for either script.

I don't think the parents can't say not to fill his medications as he is 26 years. That should be the pharmacist's call. If the pharmacist has doubt , he should call the prescriber to verify to if the lortab is legit. If it is, the pharmacist may fill it, and of course it depends on his or her clinical judgement not on what the parents say.

 

[Notecard]

Probably fill them both if there's nothing suspicious about them. If you refuse to run insurance he'll just go to another pharmacy where the little note doesn't pop up.

 

[pharmacisttobe]

I'm a student but have worked in a retail pharmacy for few years and this is what I'll do:
1. If both medications are from the same prescriber, then I 'll fill both meds and bill insurance. This is the physician's call not the parent's.
2. If the prescriptions are from different physicians and written on different dates, then I'll be more suspicious and will call the physician to double check. Then document that I called the doc's office. Then I will probably have to fill the prescription. Typically though, the patient would have thrown a fit and stormed out of the store by that point.
3. If this happened in Houston and you are working the graveyard shift, think of your safety first.

 

[rxlea]

Uhm....look at the patient. He has a BROKEN LEG.

EDIT: look, all I'm saying here is that I don't see how you would have to really sort through this for a long time. If someone has a broken leg, that's legit and they will need pain management. It's not like ibuprofen is great choice with a broken bone ya know?

Bill the insurance. Regardless of what usually happens with opioids with this guy, I'm sure the parents feel differently when he's "walking" around with a BROKEN LEG.

 

[All4MyDaughter]

This scenario is a bit ridiculous. His parents have no right to get information about, let alone influence his medical treatment. Fill.

 

[rxlea]

This scenario is a bit ridiculous. His parents have no right to get information about, let alone influence his medical treatment. Fill.

This.

 

[BenJammin]

I don't think the parents can't say not to fill his medications as he is 26 years. That should be the pharmacist's call.

1. If both medications are from the same prescriber, then I 'll fill both meds and bill insurance. This is the physician's call not the parent's.

"He is on THEIR insurance policy, not his own. If he wants to make his own call then he needs to get his own insurance policy. If I'm paying for somebody else to do something then I should have a say in what goes on."

How do you respond to that?

 

[BenJammin]

This scenario is a bit ridiculous. His parents have no right to get information about, let alone influence his medical treatment. Fill.

Would you say that this is malpractice on the part of the pharmacist if he refuses to fill because of the note?

 

[Chris co2012]

"He is on THEIR insurance policy, not his own. If he wants to make his own call then he needs to get his own insurance policy. If I'm paying for somebody else to do something then I should have a say in what goes on."

How do you respond to that?

HIPAA. They'll never know, nor is it their right to know.

 

[rxlea]

HIPAA. They'll never know, nor is it their right to know.

Yep.

 

[BenJammin]

HIPAA. They'll never know, nor is it their right to know.

If a pharmacist refuses to fill, would you consider that malpractice?

 

[pharmacisttobe]

"He is on THEIR insurance policy, not his own. If he wants to make his own call then he needs to get his own insurance policy. If I'm paying for somebody else to do something then I should have a say in what goes on."

How do you respond to that?

That's more along the lines of "if you live under my roof, you do as I say or else" but from a legal standpoint their argument doesn't hold water. No allergies to the pain med in question? legit prescription? Broken leg? Will you remember that couple of months down the road when you get the subpoena? Document what the doc says to be on the safe side in case they chose to sue/blame you for any disaster their "kid" gets himself/herself into in the future. You earned that license and you can lose it ( not in this scenario though) whether you like or hate the state of health insurance today.

 

[All4MyDaughter]

"He is on THEIR insurance policy, not his own. If he wants to make his own call then he needs to get his own insurance policy. If I'm paying for somebody else to do something then I should have a say in what goes on."

How do you respond to that?

Whoever said that is wrong. The parents don't have any right to information about their adult child's medical treatment, unless he has signed a waiver giving them access or there is a court order of some type. It doesn't matter who is paying.

 

[JoBreeze]

If the pharmacist has doubt , he should call the prescriber to verify to if the lortab is legit. If it is, the pharmacist may fill it, and of course it depends on his or her clinical judgement not on what the parents say.

Can you elaborate on what this means?

 

[BenJammin]

Would your answers change if the note, instead of what was previously stated, said "parents of patient have requested that we do not fill pain medications for their son, reason is son is recovering drug addict post-rehab with history of overdose attempts"?

 

[All4MyDaughter]

Would your answers change if the note, instead of what was previously stated, said "parents of patient have requested that we do not fill pain medications for their son, reason is son is recovering drug addict post-rehab with history of overdose attempts"?

I believe in order for the parents to make this request, there would have to be a court order or an order of guardianship. The son is an adult and presumed competent to make his own medical decisions.

 

[BenJammin]

I believe in order for the parents to make this request, there would have to be a court order or an order of guardianship. The son is an adult and presumed competent to make his own medical decisions.

That's irrelevant. What if this guy takes the medication, overdoses, and dies? You have a note on your computer from his parents telling you he's a known drug addict. How are you going to defend yourself in court?

 

[All4MyDaughter]

That's irrelevant. What if this guy takes the medication, overdoses, and dies? You have a note on your computer from his parents telling you he's a known drug addict. How are you going to defend yourself in court?

It is most definitely NOT irrelevant. For one thing, you don't even know if it's true. You need to discuss it with the patient himself and his physician. You are not legally permitted to take orders from his parents about his care without a court order or a waiver from him.

 

[JoBreeze]

That's irrelevant. What if this guy takes the medication, overdoses, and dies? You have a note on your computer from his parents telling you he's a known drug addict. How are you going to defend yourself in court?

How will you defend yourself in court when this guy sues you for obstructing his access to medical treatment?

 

[Sparda29]

this scenario is a bit ridiculous. His parents have no right to get information about, let alone influence his medical treatment. Fill.

+1

 

[awval999]

This scenario is a bit ridiculous. His parents have no right to get information about, let alone influence his medical treatment. Fill.

Whoever said that is wrong. The parents don't have any right to information about their adult child's medical treatment, unless he has signed a waiver giving them access or there is a court order of some type. It doesn't matter who is paying.

I believe in order for the parents to make this request, there would have to be a court order or an order of guardianship. The son is an adult and presumed competent to make his own medical decisions.

It is most definitely NOT irrelevant. For one thing, you don't even know if it's true. You need to discuss it with the patient himself and his physician. You are not legally permitted to take orders from his parents about his care without a court order or a waiver from him.

Patient is an adult. Patient is competent. Patient makes own medical decisions.

Parents have the right to remove patient from their health insurance if they desire.

Personally I would remove that comment from the patient's record. Has no medical reason for it to be in there.

 

[Ackj]

This scenario is a bit ridiculous. His parents have no right to get information about, let alone influence his medical treatment. Fill.

Wouldn't they get a statement with all of the things that were billed to the insurance? I'm on my parents rx coverage still, and they get a statement with my stuff on it. If that's the case, the parents would see all the rx that were billed, which would include the narcs.

 

[awval999]

Wouldn't they get a statement with all of the things that were billed to the insurance? I'm on my parents rx coverage still, and they get a statement with my stuff on it. If that's the case, the parents would see all the rx that were billed, which would include the narcs.

Pretty sure the statement would be addressed to you individually. If they open up your mail and commit a felony, well, that's not the insurance's problem.

There is no way a statement is sent with your health information on it and not addressed to you.

 

[awval999]

Here's a nice article that summarizes the topic and confirms the majority opinion here:
http://fbindependent.com/boomerang-childrens-privacy-rights-p3318-89.htm

 

[Ackj]

Pretty sure the statement would be addressed to you individually. If they open up your mail and commit a felony, well, that's not the insurance's problem.

There is no way a statement is sent with your health information on it and not addressed to you.

I'll have to ask them about it. From what I gathered, it was kind of like a bank statement where it shows all the transactions that took place for the account. Even if it was addressed to me, if it was with a bill or said something about being time-sensitive, they would've opened it so it didn't become delinquent since I'm not home monthly to read that stuff.

I know I've seen statements of that type that patients have brought in, showing me that Medco said they filled something, but the patient thought it was on our generic plan instead, or some situation like that. What they showed me had a list of all the meds and payments with fill dates.

 

[All4MyDaughter]

I'll have to ask them about it. From what I gathered, it was kind of like a bank statement where it shows all the transactions that took place for the account. Even if it was addressed to me, if it was with a bill or said something about being time-sensitive, they would've opened it so it didn't become delinquent since I'm not home monthly to read that stuff.

I know I've seen statements of that type that patients have brought in, showing me that Medco said they filled something, but the patient thought it was on our generic plan instead, or some situation like that. What they showed me had a list of all the meds and payments with fill dates.

I'm on my husband's insurance. My statements come addressed to me, not him. Our son's come addressed to whichever parent signed in at the doctor's office with him (he's a minor).

Even if, in our current scenario, the patient's parents are getting statements from his insurance company about his care, that privacy violation is the fault/responsibility of the insurance company. Someone else might be violating HIPAA, but I'm not going to.

Plus, if the parents find out about the narcs via opening their son's mail, they STILL lack standing to do anything about it. Without a court or or medical POA or something, they are not able to influence his care.

 

[MountainPharmD]

Authorized Uses and Disclosures

Authorization. A covered entity must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.44 A covered entity may not condition treatment, payment, enrollment, or benefits eligibility on an individual granting an authorization, except in limited circumstances.45

Aren't the parents paying for the health insurance their son is using? Under HIPAA they do not need their son's permission to access protected health information because they are paying for the health care their son is receiving.

I have always wondered about this in relation to medical expenses statements. Retail is psycho about not giving out medical expense statements to anyone over 18 without their permission. Wouldn't the primary on the insurance be able to request statements from everyone covered on the insurance regardless of age since they are paying for the insurance? Anyone can pick up a patients prescriptions as long as the know the name and DOB. Why so psycho on the medical expese statements especially if it is to the primary on the insurance who needs the statements for filling out taxes?

The above statement says a covered entity i.e. a pharmacy must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations. The parents are paying for the insurance correct? The minimum necessary standard still applies so the parents do not have unrestricted access to PHI but I would think as far as payment of services goes they do have a right.

 

[All4MyDaughter]

Aren't the parents paying for the health insurance their son is using? Under HIPAA they do not need their son's permission to access protected health information because they are paying for the health care their son is receiving.

I have always wondered about this in relation to medical expenses statements. Retail is psycho about not giving out medical expense statements to anyone over 18 without their permission. Wouldn't the primary on the insurance be able to request statements from everyone covered on the insurance regardless of age since they are paying for the insurance? Anyone can pick up a patients prescriptions as long as the know the name and DOB. Why so psycho on the medical expese statements especially if it is to the primary on the insurance who needs the statements for filling out taxes?

The above statement says a covered entity i.e. a pharmacy must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations. The parents are paying for the insurance correct? The minimum necessary standard still applies so the parents do not have unrestricted access to PHI but I would think as far as payment of services goes they do have a right.

I think disclosures related to payment primarily mean to third party insurance, HMOs, PBMs, etc. But even the law does permit the patient's parents to get a statement of the charges filed through their insurance, it most certainly does NOT permit them to make medical decisions on their adult son's behalf, as they are attempting to in this scenario.

As far as people other than the patient picking up meds at the pharmacy, my understanding is that it's a legal gray area. I've been told that we are supposed to make a "good faith" effort to determine that the person presenting for pick up is an authorized representative of the patient. What that "good faith" effort should be seems to be undetermined. At my pharmacy, we do try to document who is allowed (and who is NOT allowed) to pick up for our patients (we put it in the computer) and we have definitely called to check with a patient if something seems off. We require the PATIENT to call and request medical expense statements, but we do permit someone else to pick them up as long as the patient specifically tells us who will be picking them up. We don't assume consent to release the expense statements to the person authorized to pick up prescriptions (spouse, child, caregiver). Meaning, that if my husband normally gets my RXs, and we want a statement, he cannot request it. I have to call and say, "Please print a medical expense statement and give it to my husband Mr. A4MD." I think we are pretty careful about this stuff. I've worked at chain pharmacies that are a lot more lax about it. On the flip side, I also worked at the VA which was extremely strict, and all disclosures had to go through the privacy officer.

 

[MountainPharmD]

I think disclosures related to payment primarily mean to third party insurance, HMOs, PBMs, etc. But even the law does permit the patient's parents to get a statement of the charges filed through their insurance, it most certainly does NOT permit them to make medical decisions on their adult son's behalf, as they are attempting to in this scenario.

As far as people other than the patient picking up meds at the pharmacy, my understanding is that it's a legal gray area. I've been told that we are supposed to make a "good faith" effort to determine that the person presenting for pick up is an authorized representative of the patient. What that "good faith" effort should be seems to be undetermined. At my pharmacy, we do try to document who is allowed (and who is NOT allowed) to pick up for our patients (we put it in the computer) and we have definitely called to check with a patient if something seems off. We require the PATIENT to call and request medical expense statements, but we do permit someone else to pick them up as long as the patient specifically tells us who will be picking them up. We don't assume consent to release the expense statements to the person authorized to pick up prescriptions (spouse, child, caregiver). Meaning, that if my
husband normally gets my RXs, and we want a statement, he cannot request it. I have to call and say, "Please print a medical expense statement and give it to my husband Mr. A4MD." I think we are pretty careful about this stuff. I've worked at chain pharmacies that are a lot more lax about it. On the flip side, I also worked at the VA which was extremely strict, and all disclosures had to go through the privacy officer.

This is exactly my point. The whole thing is a gray area. In retail anyone can pick up a patients actual medication as long as they know the patients name and DOB. Oh but a big HIPAA violation if you want to pick up a list of a patients medications. The actual med no problem, a list of meds no way! It doesn't make sense. The same standard should apply to whatever a patient is picking up from the pharmacy. A prescription should be treated no different than a medical expense statement.

The permitted disclosures by a covered entity does not specifically state payment limited to an insurance company. I would argue it also covers payment by a third party individual. When an adult agrees to be covered by a parents insurance plan do they not in effect give the primary on the insurance defacto authorization to access PHI related to payment by the plan?

 

[All4MyDaughter]

This is exactly my point. The whole thing is a gray area. In retail anyone can pick up a patients actual medication as long as they know the patients name and DOB. Oh but a big HIPAA violation if you want to pick up a list of a patients medications. The actual med no problem, a list of meds no way! It doesn't make sense. The same standard should apply to whatever a patient is picking up from the pharmacy. A prescription should be treated no different than a medical expense statement.

I think most pharmacies are probably being too lax about who they allow to pick up prescriptions. I know that most are too lax about documenting who is allowed to pick up for certain patients. It would be interesting to see how that would play out if someone made a formal HIPAA complaint.

The permitted disclosures by a covered entity does not specifically state payment limited to an insurance company. I would argue it also covers payment by a third party individual. When an adult agrees to be covered by a parents insurance plan do they not in effect give the primary on the insurance defacto authorization to access PHI related to payment by the plan?

Did you read the article posted above by awval999? It says that being on the parents' insurance does NOT waive adult children's privacy rights. Here's the link again: http://fbindependent.com/boomerang-childrens-privacy-rights-p3318-89.htm

 

[MountainPharmD]

I think most pharmacies are probably being too lax about who they allow to pick up prescriptions. I know that most are too lax about documenting who is allowed to pick up for certain patients. It would be interesting to see how that would play out if someone made a formal HIPAA complaint.



Did you read the article posted above by awval999? It says that being on the parents' insurance does NOT waive adult children's privacy rights. Here's the link again: http://fbindependent.com/boomerang-childrens-privacy-rights-p3318-89.htm

The article is not an official government document. Basically it is the interpretation of the author. I never said the patients privacy rights are waived. I am simply saying the primary on the insurance as a right to access information regarding payment for services covered by the insurance policy. The adult child agreeing to be covered on the insurance is in mynopinion a defacto authorization for the primary card holder to have access to the PHI related to that insurance.

 

[All4MyDaughter]

The article is not an official government document. Basically it is the interpretation of the author. I never said the patients privacy rights are waived. I am simply saying the primary on the insurance as a right to access information regarding payment for services covered by the insurance policy. The adult child agreeing to be covered on the insurance is in mynopinion a defacto authorization for the primary card holder to have access to the PHI related to that insurance.

All right so maybe they get a list of claims billed. I still think it will come addressed to the son.

They still don't have the right to discuss or influence their son's medical condition with his providers without his permission. They can't say "Don't fill this or that" without evidence of a court order or legal guardianship.

 

[ucrx]

That's irrelevant. What if this guy takes the medication, overdoses, and dies? You have a note on your computer from his parents telling you he's a known drug addict. How are you going to defend yourself in court?

Even if someone has an addiction, it doesn't mean their pain should go untreated.

The above statement says a covered entity i.e. a pharmacy must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations. The parents are paying for the insurance correct? The minimum necessary standard still applies so the parents do not have unrestricted access to PHI but I would think as far as payment of services goes they do have a right.

Is the disclosure needed for you (your institution) to be paid for services? If no, then I interpret is as not being permitted by HIPAA.

 

[MountainPharmD]

All right so maybe they get a list of claims billed. I still think it will come addressed to the son.

They still don't have the right to discuss or influence their son's medical condition with his providers without his permission. They can't say "Don't fill this or that" without evidence of a court order or legal guardianship.

Why not? If they are paying for the insurance do they not have a right to know and monitor how it is being used?

What if the individual went to an out of network provider? Do you think the parents would want to know or be able to control what the adult child is doing? An out of network procedue could cost thousands of dollars. If I am paying for the insurance I would darrn sure want some control and input as to how it would be used.

 

[Sparda29]

Perhaps a solution to the OP's question. It's late in the afternoon, so you should be able to get in contact with the doctor from the hospital. Let the doctor know about potential addiction issues because of that note being on the patient's profile. Perhaps the Lortab can be switched to Toradol?

 

[BidingMyTime]

Perhaps a solution to the OP's question. It's late in the afternoon, so you should be able to get in contact with the doctor from the hospital. Let the doctor know about potential addiction issues because of that note being on the patient's profile. Perhaps the Lortab can be switched to Toradol?

Toradol for a broken leg???? Really???? Toradol is limited to 5 days max use, I suspect he will need longer pain control than that for a broken leg.

My understanding of the law.....which could be totally wrong.....parents have absolutely no say in their adult children's medical treatment. If the parents don't want to pay for their adult child's pain RX's, than they have the right to NOT put him on their policy. But there is no gray area or picking & choosing....either the parents put him on their policy, at which point, the adult child can use the benefits of that policy however he chooses, or they can elect to not put him on their policy.



Now a more gray & iffy area, and one which unfortunately comes up too often, divorced parents, 1 parent has custody & non-custodial parent provides the insurance, but non-custodial parent doesn't want the insurance used for certain kinds of prescriptions (ADHD drugs, antipsychotics), etc which the custodial parent says their child needs. Pharmacist is stuck in the middle...

 

[Sparda29]

Toradol for a broken leg???? Really???? Toradol is limited to 5 days max use, I suspect he will need longer pain control than that for a broken leg.

My understanding of the law.....which could be totally wrong.....parents have absolutely no say in their adult children's medical treatment. If the parents don't want to pay for their adult child's pain RX's, than they have the right to NOT put him on their policy. But there is no gray area or picking & choosing....either the parents put him on their policy, at which point, the adult child can use the benefits of that policy however he chooses, or they can elect to not put him on their policy.



Now a more gray & iffy area, and one which unfortunately comes up too often, divorced parents, 1 parent has custody & non-custodial parent provides the insurance, but non-custodial parent doesn't want the insurance used for certain kinds of prescriptions (ADHD drugs, antipsychotics), etc which the custodial parent says their child needs. Pharmacist is stuck in the middle...

Ibuprofen after the Toradol treatment? I've had surgery on my knee before for ACL reconstruction + microfracture to stimulate cartilage growth. Honestly, after the 3rd day, I didn't need any more pain killers.

 

[SHC1984]

Ibuprofen after the Toradol treatment? I've had surgery on my knee before for ACL reconstruction + microfracture to stimulate cartilage growth. Honestly, after the 3rd day, I didn't need any more pain killers.

Why not Tramadol with APAP? I really like that stuff when I was on it. It's better than Lortab IMO.

 

[SHC1984]

You are a floater working for a chain. It is late in the afternoon and a 25 year old man comes to the pharmacy. He drops off two prescriptions: doxycycline for an infection and lortab for a broken leg. He makes the comment that he cannot afford cash prices for any of these drugs so he hands you his insurance card. Upon receiving his insurance information, you find out that he is still on his parent's insurance coverage due to Obama's health care reform (which will cover him until he's 26). You begin to enter the scripts when a note pops up from another pharmacist. It says "parents of patient have requested that we do not fill pain medications for their son, reason unspecified". You call the manager and they tell you to do what you think is right.

What do you do? Do you refuse to fill the lortab but dispense the doxy? Do you go ahead and fill it while billing it on insurance? Remember that he cannot afford the cash price for either script.

Who can't afford to pay generic Lortab cash? It's dirt cheap.

 

[MountainPharmD]

Perhaps a solution to the OP's question. It's late in the afternoon, so you should be able to get in contact with the doctor from the hospital. Let the doctor know about potential addiction issues because of that note being on the patient's profile. Perhaps the Lortab can be switched to Toradol?

Oh Sparda.....

 

[MountainPharmD]

My understanding of the law.....which could be totally wrong.....parents have absolutely no say in their adult children's medical treatment. If the parents don't want to pay for their adult child's pain RX's, than they have the right to NOT put him on their policy. But there is no gray area or picking & choosing....either the parents put him on their policy, at which point, the adult child can use the benefits of that policy however he chooses, or they can elect to not put him on their policy....

Yes and in the same light the child gives up some of their privacy rights when they agree to be on the parents insurance. And no I do not agree that the adult child gets to use the benefits however they see fit. It is a mutual agreement between the parent and the child to use the insurance. The adult child does not have a blank check so to speak to do whatever they want with thre insurance. The primary on the insurance still has control over it and how it can be used.

 

[Sparda29]

Why not Tramadol with APAP? I really like that stuff when I was on it. It's better than Lortab IMO.

Still potentially addictive.

 

[SHC1984]

Yes and in the same light the child gives up some of their privacy rights when they agree to be on the parents insurance. And no I do not agree that the adult child gets to use the benefits however they see fit. It is a mutual agreement between the parent and the child to use the insurance. The adult child does not have a blank check so to speak to do whatever they want with thre insurance. The primary on the insurance still has control over it and how it can be used.

I agree. I am still on my family's cellphone plan and car insurance....my parents decide on what I get on my phone and car etc.

I am the only person I know that doesn't have an IPhone 4 b/c my parents still pays for my cellphone bills.

I don't get to choose b/c I don't pay.

My parents also get a list of the numbers I call every month b/c I am on their cellphone plan...I waive my right to privacy since I am on their plan.

 

[BidingMyTime]

Ibuprofen after the Toradol treatment? I've had surgery on my knee before for ACL reconstruction + microfracture to stimulate cartilage growth. Honestly, after the 3rd day, I didn't need any more pain killers.

If this guy had previous addiction problems, then his narcotic tolerance is going to be much higher than the average person. He will probably need a higher dose of narcotic to effectively treat his pain.

The question is "if".....I don't think some comment from his parents qualifies as an actual health care record. Perhaps his parents are psycho or have Manchusan's by proxy and just totally made up that statement. The statement doesn't even say that his parents alledged he had drug addiction problems, just that they didn't want him to have pain killers. Personally, I would NOT have added such an ambiguous statement to a pt's profile, nor would I make treatment decisions based on it.

If there was actual evidence of his having drug addiction problems, that would be worth bringing to the physicians attention--not so he would refuse to give narcotics to the patient, but so the physician would know to watch the quantity and refills of such narcotics. Addiction is not a contraindication to narcotics, but it is a reason for closely monitoring usage of narcotics.

 

[BidingMyTime]

Yes and in the same light the child gives up some of their privacy rights when they agree to be on the parents insurance. And no I do not agree that the adult child gets to use the benefits however they see fit. It is a mutual agreement between the parent and the child to use the insurance. The adult child does not have a blank check so to speak to do whatever they want with thre insurance. The primary on the insurance still has control over it and how it can be used.

You don't agree legally or ethically? I would be surprised if the law was on your side, but since I can't point to the law, I'm not sure. I can just see all kinds of troublesome scenarios arising......so a husband could demand to see his wife's prescription records and refuse to allow his insurance to be used to pay for her birth control? A wife could demand to see her husband's prescriptions and refuse to allow her insurance to be used to pay for Viagra? Adult child or adult partner under a covered plan...I can't see any legal difference, but I really doubt that HIPAA gives an exclusion to the privacy rights of family members who share a health plan.

Perhaps it's different with health insurance plans, but with mine, I get a print-out of the provider and the family member that used them.....I do not get details on the specific treatment provided. Granted there is some privacy lost in knowing the provider, but that is still a far step from getting specific treatment details on an adult, much LESS to be able to dictate the treatment.

And legally, how could dictating the treatment be done? If I bill an insurance for a valid treatment, I'm going to get paid for it. What is the insurance holder going to do after the fact? Call the insurance and say he didn't want his ADULT child to get the treatment and so the charges should be reversed? Do you really think the insurance is going to take his request seriously? As a provider, there is NO law that says I can't bill an insurance for a service legally provided, just because the primary insurance holder didn't get permission. There is no law saying that I have to request permission from the primary insurance holder to bill an insurance. Adult children....and even in some cases minor teenagers, can certainly give legal consent to treatment, and the provider can certainly bill their insurance that they are covered under.

 

[SHC1984]

You don't agree legally or ethically? I would be surprised if the law was on your side, but since I can't point to the law, I'm not sure. I can just see all kinds of troublesome scenarios arising......so a husband could demand to see his wife's prescription records and refuse to allow his insurance to be used to pay for her birth control? A wife could demand to see her husband's prescriptions and refuse to allow her insurance to be used to pay for Viagra? Adult child or adult partner under a covered plan...I can't see any legal difference, but I really doubt that HIPAA gives an exclusion to the privacy rights of family members who share a health plan.

Perhaps it's different with health insurance plans, but with mine, I get a print-out of the provider and the family member that used them.....I do not get details on the specific treatment provided. Granted there is some privacy lost in knowing the provider, but that is still a far step from getting specific treatment details on an adult, much LESS to be able to dictate the treatment.

And legally, how could dictating the treatment be done? If I bill an insurance for a valid treatment, I'm going to get paid for it. What is the insurance holder going to do after the fact? Call the insurance and say he didn't want his ADULT child to get the treatment and so the charges should be reversed? Do you really think the insurance is going to take his request seriously? As a provider, there is NO law that says I can't bill an insurance for a service legally provided, just because the primary insurance holder didn't get permission. There is no law saying that I have to request permission from the primary insurance holder to bill an insurance. Adult children....and even in some cases minor teenagers, can certainly give legal consent to treatment, and the provider can certainly bill their insurance that they are covered under.

Also good points.

I guess the parents could always choose to take the adult child OFF of their insurance and kick him out of the house if they find him troublesome too right?

I mean does the law say YOU HAVE TO PAY for your adult child's insurance???

If the parent is NOT obligated to pay for the adult child's insurance...then they can always choose NOT to put the adult child on their plan. PROBLEM solved.

You can argue that the parents CHOSE to agree to put the child on their plan so they agree to let him take whatever drug he wants to take.

If the parents does NOT want to pay for his health insurance...they always have the choice of removing him off.

 

[All4MyDaughter]

You don't agree legally or ethically? I would be surprised if the law was on your side, but since I can't point to the law, I'm not sure. I can just see all kinds of troublesome scenarios arising......so a husband could demand to see his wife's prescription records and refuse to allow his insurance to be used to pay for her birth control? A wife could demand to see her husband's prescriptions and refuse to allow her insurance to be used to pay for Viagra? Adult child or adult partner under a covered plan...I can't see any legal difference, but I really doubt that HIPAA gives an exclusion to the privacy rights of family members who share a health plan.

Perhaps it's different with health insurance plans, but with mine, I get a print-out of the provider and the family member that used them.....I do not get details on the specific treatment provided. Granted there is some privacy lost in knowing the provider, but that is still a far step from getting specific treatment details on an adult, much LESS to be able to dictate the treatment.

And legally, how could dictating the treatment be done? If I bill an insurance for a valid treatment, I'm going to get paid for it. What is the insurance holder going to do after the fact? Call the insurance and say he didn't want his ADULT child to get the treatment and so the charges should be reversed? Do you really think the insurance is going to take his request seriously? As a provider, there is NO law that says I can't bill an insurance for a service legally provided, just because the primary insurance holder didn't get permission. There is no law saying that I have to request permission from the primary insurance holder to bill an insurance. Adult children....and even in some cases minor teenagers, can certainly give legal consent to treatment, and the provider can certainly bill their insurance that they are covered under.

I agree with you, and think the law is on your side. Although my husband pays for our insurance, he still cannot get information about my treatment or talk to any of my providers without my permission. None of the insurance companies/PBMs will deal with him either, even though he is listed as responsible party on our account and pays the bills. I have to give them permission to talk to him (which I do) and renew it annually.

I used to be the privacy officer for a college where I worked in Student Affairs. I turned down numerous requests for information about student grades, disciplinary matters, class schedule, etc from parents who felt they were entitled to the information because they were paying tuition. FERPA (the education version of HIPAA) is very clear that adult students have privacy rights regardless of who is paying the bills for college. I doubt HIPAA is different.

 

[All4MyDaughter]

I agree. I am still on my family's cellphone plan and car insurance....my parents decide on what I get on my phone and car etc.

I am the only person I know that doesn't have an IPhone 4 b/c my parents still pays for my cellphone bills.

I don't get to choose b/c I don't pay.

My parents also get a list of the numbers I call every month b/c I am on their cellphone plan...I waive my right to privacy since I am on their plan.

There are no laws pertaining to the privacy of cell phone plans or car insurance. The account holder/car owner calls the shots. There's no HIPAA for these things.

If my children are still mooching off me when they are nearly 30, you can BET that I'll be controlling what cell phone they have, what type of plan, what they drive, etc.

But health care is different.

 

[SHC1984]

I used to be the privacy officer for a college where I worked in Student Affairs. I turned down numerous requests for information about student grades, disciplinary matters, class schedule, etc from parents who felt they were entitled to the information because they were paying tuition. FERPA (the education version of HIPAA) is very clear that adult students have privacy rights regardless of who is paying the bills for college. I doubt HIPAA is different.

The law does really favor the adult child over the parents in every case.

I would hate to be paying 40K a year for John's tuition while he is failing out and partying every semester! 🙄

But again...the arguement would be the parent always have the right to NOT pay.

I think the ONLY thing the parents can do is STOP paying for everything.