Help Me Clear Up a Bet!!

horskj

New Member
17
I remember during AHIP training that CMS had determined that agents were authorized representatives of the plan thus they did not need the member with them to speak to member services of a plan. I have a vendor that is telling me that it is a HIPAA violation to speak to me without the member on the line.
Dose anyone have a publication or a rescore that I can go to in order to prove my point.

It is always fun to shut down these front line so called customer service reps!!
 
If it's a carrier rep (w2) then I would that makes sense, but if it's an external agent I can see how that would make a difference. Realistically the agent might have been "fired" by the client so I can see why they would want to be cautious.
 
If it's a carrier rep (w2) then I would that makes sense, but if it's an external agent I can see how that would make a difference. Realistically the agent might have been "fired" by the client so I can see why they would want to be cautious.


I should have made it a little clearer...they were able to determine that I was indeed the AOR and the plan was inforce.
 
MA and PDP plans have never been cooperative with me. I've had a few that have gave me the information I was requesting but most do blame HIPAA. I argue with them why am I getting paid if I can't assist my clients. They don't seem to care and said I must be with the client or do 3 way call.
 
I should have made it a little clearer...they were able to determine that I was indeed the AOR and the plan was inforce.

That only changes things slightly. It's a good policy for them to want the client on the phone, hipaa violation or not
 
The agent is covered by the HIPAA.

But companies will continue to hide behind it to not give info to the agents.

It's just how it is. You can prove it to this one *** at the company but ten you will have to repeat it every time.

Once proven wrong then they will change to it's their policy to not share with the agent.

Once they dig in they are not sharing.
 
That only changes things slightly. It's a good policy for them to want the client on the phone, hipaa violation or not

I admit I don't do MA, but I have yet to find a company that will release health information to the agent that the agent did not already know. There are some companies that won't discuss any health information without the client's permission, even if the agent was previously aware of it.
 
That only changes things slightly. It's a good policy for them to want the client on the phone, hipaa violation or not

Why do you say that? As the writing and "servicing" agent that is why my clients place their trust in me. They need something or have a problem they should not be expected to wait around while we make calls...get placed on hold...get transferred...ect, ect,.

Here is another one for you to think about... as the AOR we have all the information that the CS reps would need to confirm the member, other than being completely wrong and an ethical violation, we could just say we are the member and confirm the information. So...if it truly was a HIPAA thing then the plan should require the member to go to a plan office and confirm their identity.
 
Why do you say that? As the writing and "servicing" agent that is why my clients place their trust in me. They need something or have a problem they should not be expected to wait around while we make calls...get placed on hold...get transferred...ect, ect,.

Here is another one for you to think about... as the AOR we have all the information that the CS reps would need to confirm the member, other than being completely wrong and an ethical violation, we could just say we are the member and confirm the information. So...if it truly was a HIPAA thing then the plan should require the member to go to a plan office and confirm their identity.

I don't necessarily disagree with your points, but it's still exposing the carrier to a legitimate complaint and potential lawsuit vs adding one verification.
 
Why do you say that? As the writing and "servicing" agent that is why my clients place their trust in me. They need something or have a problem they should not be expected to wait around while we make calls...get placed on hold...get transferred...ect, ect,.

Here is another one for you to think about... as the AOR we have all the information that the CS reps would need to confirm the member, other than being completely wrong and an ethical violation, we could just say we are the member and confirm the information. So...if it truly was a HIPAA thing then the plan should require the member to go to a plan office and confirm their identity.

Here is the thing. They made an effort to verify and in your cause you would have been impersonating someone else.

It is the same with our files. It is impossible to make them impossible to steal, however we can certainly takes steps to protect them against most attempts.
 
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