Health insurance or to pay out-of-pocket?

[Jesse910]

In a nutshell, the cost of private medical insurance in the U.S. became so cost prohibitive that after 20+ years, I'm now utilizing my employer's medical insurance which has made me very uncomfortable within the past month. I had more control over my situation when I paid out-of-pocket. Now, there is always the possibility of being discovered.

In making the transition to employer insurance, I also had to find a new doctor willing to write my prescriptions and monitor my labs to forego visits to a shrink. I've been on the same meds for well over 10 years and they still work. He consented after I assured him that I was still seeing my therapist and would tell him if something came up. Although, I don't know if I will feel comfortable saying anything other than "I'm okay" to him for fear that it will end up in my medical records. When I asked how much information about this visit would he put into the records, he stated that it would be billed as a consultation. Yet, in the future, he would have to code it correctly in order to be paid.

To add insult to injury, I now have to deal with a pharmacy ascertain how they will code their information that goes to the insurance company as well.

My employer knows nothing about my medical condition. And, I don't want them finding out now. I have been able to work without any incidents for years. I do not take my situation lightly.

My question is this, how safe is my medical information? Everything I've read doesn't give me any reassurance especially when the employer is paying. Can I be fired from my job if the insurance company were to alert my employer?

 

[David Baxter PhD]

Perhaps somebody can correct if if there is something different about how the US system works, but you have rights to confidentiality as a patient I don't believe your employer has the right to access any information from the insurer or your doctors unless you sign an authorization to allow it.

The employer is not covering your medical or prescription costs. The employer is paying all or part of the premiums for your insurance coverage as one of the benefits given to employees. That doers not give the employer access to any information at all about why or how you are using those benefits.

 

[Jesse910]

David:

I am encouraged by your response. It makes good sense. Yet, when I signed up for the insurance and when I visited the doctor, there is language contained in both forms I had to sign that states that information may be dispersed to third parties (one of which could be an employer). I don't know if that gave permission away when I signed the documents. And, will I continue to give it away each and every time that I go to a doctor's visit and a discussion about whether I'm doing okay mentally comes up. Additionally, I don't know if I'm safe from a possible breach in confidentiality when I go to the pharmacy. I do know that a patient in the U.S. can request that their physician maintain their privacy by signing a request to do so. Or, they can write a letter to their doctor and bring it to the appointment. I know that an employer has to have cause for reviewing a person's medical records (irratic behavior, making threats against another employee, taking too much time off from work for medical appointments, etc.) However, I've been trying to ascertain whether it is legal or not for an insurance company to alert an employer to an employee's medical condition?

Thanks again for your comments.

 

[David Baxter PhD]

Jesse, all health care professionals, physicians, nurses, psychologists, pharmacists, etc., are required by the College or Board that licenses them to maintain confidentiality. In Canada (and as far as I know the US), increasingly even regular businesses are required to abide by privacy laws.

Now, should you go on long term disability, the insurer has a right to request some of your medical records. You must authorize that but if you refuse to give authorization, disability benefits may be denied. However, that doesn't see to be the case for you.

There are also a few high security positions where your medical records would be pertinent to the performance of your job and you would then be required to authorize the release of records in that case, but I'm talking here about sensitive security positions like the FBI, CIA, armed forces, etc. That won't apply to most people.

Again, I don't think you need worry about the employer having access at this tiume, but I would suggest as a starting point that you contact the insurance company where you make your claims, and perhaps also your doctor, and determine what you have authorized currently regarding release of information. If you are not comfortable, you have the right to withdraw that authorization.

 

[Jesse910]

I read you David. You've helped to ease my mind. Thanks for the information.