Can A Spouse Ask Medical Billing Questions Over The Phone?

Yes. The HIPAA Privacy Rule, found at 45 CFR 164.510(b), allows covered entities to exchange information that is directly related to a patient’s spouse, family members, friends, or other individuals identifiable by the patient’s involvement in the patient’s care or payment for health care. If the patient is present or otherwise available prior to the disclosure and has the capacity to make health-care decisions, the covered entity may share this information with the patient’s family and these other individuals if the patient agrees or does not object when given the opportunity. If the covered entity may fairly assume, based on professional judgment, that the patient does not object, it may additionally disclose relevant information with the patient’s family and these other people. For instance, in these circumstances:

  • A doctor may notify a friend driving the patient home from the hospital about the patient’s mobility limits.
  • When a patient’s roommate comes to pick up her buddy from the hospital, a doctor may counsel her on adequate prescription dosage.
  • When a patient brings a friend to a medical appointment and requests if the friend can come into the treatment room, a physician may discuss the patient’s treatment with the friend there.

Even if the patient is not present or it is impracticable for the covered entity to ask the patient about discussing her care or payment with a family member or other person due to emergency circumstances or the patient’s incapacity, the covered entity may share this information with the person if, in exercising professional judgment, it determines that doing so is in the best interest of the patient. See 45 CFR 164.510 for more information (b). Consider the following example:

  • A surgeon may advise a patient’s spouse, who accompanied her husband to the emergency room, that the patient has suffered a heart attack and provide monthly updates on the patient’s condition and prognosis, provided this is compatible with professional judgment.
  • If a doctor’s professional judgment allows it, he or she may discuss an incompetent patient’s condition with a family member over the phone.

Furthermore, the Privacy Rule expressly allows a covered entity to make reasonable inferences about a patient’s best interests based on professional judgment and experience with common practice when allowing another person to pick up a filled prescription, medical supplies, X-rays, or other similar forms of protected health information on the patient’s behalf. For example, if a person goes to a pharmacy and asks to pick up a prescription on behalf of someone he knows by name, the pharmacist may allow it based on professional judgment and expertise with customary practice.

Is it possible to discuss medical information over the phone?

Your health care professional may share your information with you in person, over the phone, or in writing under HIPAA. If you grant your health care provider or health plan permission to share pertinent information, the provider or plan may do so. You are present and do not object to the information being shared.

Is it possible for family members to break HIPAA?

Unless the patient is a kid, a spouse, or has designated them as a personal representative, HIPAA does not provide family members the ability to examine patient records, even if they are paying for healthcare premiums.

However, there are a few exceptions and circumstances in which HIPAA permits the sharing of patient data with family members or others.

Is it HIPAA-compliant to make phone calls?

The situation with HIPAA and patient phone calls is more difficult because the nature of patient phone calls may be contingent on whether the patient has granted their agreement to be contacted by phone by the Covered Entity. If a patient provides the Covered Entity with a phone number, they are presumed to have given their agreement to receive healthcare-related phone calls and texts. Allowable justifications for patient phone calls are, however, limited to:

Even if consent is presumed to have been provided, HIPAA telephone restrictions still apply to patient calls. For example, calls to patients should begin with the Covered Entity declaring their identity and the reason for the call, should last no more than sixty seconds, and should not be made more than three times per week for “allowable” reasons. Any other type of contact, such as a phone call or a text message, requires the patient’s specific permission.

If a patient is unavailable when a Covered Entity calls, the Covered Entity may need to obtain the patient’s agreement to leave a message. Many patients will consent to a voice message being left with a family member or other person involved in their care, but they may not consent to a voice message being left on an answering machine if the machine is accessible to people who share the patient’s home or workplace.

What information can be provided without infringing on HIPAA regulations?

Individually identifiable health information relating to an individual’s past, present, or future health status that is created, collected, transmitted, or maintained by a HIPAA-covered entity in connection with the provision of healthcare, payment for healthcare services, or use in healthcare operations is considered protected health information under HIPAA (PHI healthcare business uses).

Under HIPAA, health information such as diagnoses, treatment information, medical test results, and prescription information, as well as national identification numbers and demographic information such as birth dates, gender, ethnicity, and contact and emergency contact information, are considered protected health information. Physical records are considered PHI, but ePHI refers to any PHI that is created, stored, communicated, or received electronically.

PHI only applies to information on patients or members of health plans. It excludes information from educational and employment records, as well as health information kept by a HIPAA-covered entity in its capacity as an employer.

When an individual can be identified from the information, it is considered PHI. When all identifiers are removed from health data, it no longer qualifies as protected health information, and the HIPAA Privacy Rule’s limitations on uses and disclosures are no longer in effect.

What are the HIPAA rules for phone calls?

Patients will not be charged for phone calls or text messages, and calls will only be made to the patient’s given wireless phone number. At any moment, patients have the ability to rescind their agreement to receive phone calls or text messages. Patients must be given the option to opt out of receiving future messages.

In what circumstances is it legal for a healthcare professional to share patient information?

A health care provider may share a patient’s information with family, friends, or others involved in the patient’s care or payment for care if the patient is not present or incapacitated, as long as the health care provider determines, based on professional judgment, that doing so is in the best interests of the patient.

Is it possible for me to examine my husband’s medical records?

Because health and care records are private, you can only access someone else’s records if you’ve been given permission to do so. You must be acting on someone else’s behalf with their consent, or you must have legal capacity to make decisions on their behalf (power of attorney), or you must be acting on their behalf with their consent.