NAII Gives ‘Thumbs Up’ to ‘HHS’ Privacy Guidance Document

July 17, 2001

The National Association of Independent Insurers (NAII) gave high marks to the Health and Human Services Administration’s (HHS) first guidance document incorporating clarifications to its regulation on protecting the privacy of medical information.

Nancy Schroeder, NAII assistant vice president, workers’ compensation, stated that the most important clarification was that the ‘minimum necessary requirement’ does not apply to property/casualty insurers seeking claims information from medical providers and other covered entities.

According to Schroeder, this change in the guidance will benefit auto and liability insurers, as well as consumers, by supporting speedier claims handling, reduced litigation and vigorous defenses of all policyholders.

NAII explained that currently, property/casualty insurance companies operate under the state law requirements with regard to obtaining medical information for the handling of claims. Insurers generally obtain authorizations for first party and other lines of casualty insurance. For medical payments, insurers often need current and past treatment history on conditions that could impact the claim. Regarding liability coverage, insurers generally do not pay directly for health care, but are called upon by policyholders to provide defense in court and to pay settlements brought by third parties.

Schroeder said under the revised HHS guidance, insurers can now investigate a claim and can access complete information, adding that it is hoped this important clarification will not get lost in the confusion when the regulation is implemented.

On workers’ comp issues, NAII expressed disappointment in that the HHS guidance did not address the workers’ comp component of the HHS regulation. Without new language to correct the problem, handling of workers’ comp claims could be seriously impeded, according to Schroeder.

NAII also suggests that HHS should clarify the provision that gives the provider and claimant the ability to agree to limit release of information so that it is clear that it does not apply to property/casualty claimants.

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