Short story- my wife’s ex claimed to have paid a bill, said our insurance “isn’t active” and that we owe him half. It’s a lot of money and since my wife is unable to call to see if we can add our insurance towards the bill, can i call? I wouldn’t be accessing my step daughter’s medical history, just the statement. Or is that still a HIPAA violation or is that something that can get my wife in trouble with her ex; legal wise? Please help. Thanks.
Can’t hurt to try. At least ask the provider what documentation they need to speak to you about the billing account, like maybe your wife can give you a limited power of attorney.
If it’s her insurance, your wife needs to call.
Not a lawyer but someone who works in the medical field… of you call the insurance or the billing office and can confirm your step daughters name and DOB then you’re considered verified by HIPAA. Sounds like you know enough about the bill and the claim to be considered in the know… Which basically means you can call and offer insurance information in most cases
Why can’t wife call?
Whose insurance is supposed to pay? If you’re the policy holder, then HIPAA allows you to inquire about payment issues, since you are the responsible party.
Teagan said:
Whose insurance is supposed to pay? If you’re the policy holder, then HIPAA allows you to inquire about payment issues, since you are the responsible party.
Its her own policy since that was apart of their custody agreement. They each are required to have their own policy and my wife didn’t need me to add my step daughter to mine since she has great benefits.
@Maxwell
Why is your wife unable to call about her insurance for her child?
@Maxwell
Then your wife needs to call
Call your insurance first and see if it was processed. And then call the provider and ask if your insurance is noted on the patient’s account and if not, give them the information to add them and reprocess the claim. Ex can then go for a refund of the difference.
Itemized receipt is key here.
Proof your insurance is “not active”
Your wife can and must call and have her get an email confirmation.
Without any of these, no bank.
If they sue, they will have to provide all of this for the court.
Why is your wife unable to call? Why does she not ask for a receipt from the ex? It’s pretty common to have to provide receipts when expecting repayment.
It’s definitely not a HIPAA violation for you, you’re not a covered entity and therefore HIPAA does not apply to you. It could be a HIPAA violation for the medical provider depending on what they tell you. That’s for them to worry about. Many will just refuse to talk to you out right because they want to be careful in that regard.
I don’t think your wife can get into legal trouble per se. It’s not illegal for you to call, as long as you’re truthful and don’t lie and try to impersonate one of the parents. The ex might be able to spin this in some way to support some claim that the judge finds sympathetic, hard to know without a lot more information.
If you do call offer to pay the bill. That might encourage them to speak to you, at which point you might discover whether they have a balance or not.
@Van
She’s military and has been extremely busy until around 7/7:30pm for the past year. She’s asked but he said it wasnt his job to provide it and if she wants to question him then to go to court.
Maxwell said:
@Van
She’s military and has been extremely busy until around 7/7:30pm for the past year. She’s asked but he said it wasnt his job to provide it and if she wants to question him then to go to court.
If he goes to court he will have to provide the paperwork she’s asking for
Maxwell said:
@Van
She’s military and has been extremely busy until around 7/7:30pm for the past year. She’s asked but he said it wasnt his job to provide it and if she wants to question him then to go to court.
Well if he wants payment he can do the same.
But seriously if she has the name of the physician or whoever provided the medical services she should be able to call them and ask them to submit the charges to her insurance carrier.
I presume she gets lunch every day at some point so she needs to make the time to do this.
Maxwell said:
@Van
She’s military and has been extremely busy until around 7/7:30pm for the past year. She’s asked but he said it wasnt his job to provide it and if she wants to question him then to go to court.
1- TRICARE has an online component that will allow her and you to look at her insurance at any time.
2- TRICARE is always active for the Active Duty Service member, but for dependents, TRICARE is tied to the ID card in DEERS. ID cards need to be renewed every 4 years. Your wife NEEDS to check on both your StepKid and YOUR ID cards.
3- TRICARE is legally 2nd payer if the patient has other other insurance. For TRICARE to pay as second payer, you will have to submit the itemized (ie with codes) Doctors Bill and the EOB from what the Primary Insurance showing what that HMO paid. Because while TRICARE is a secondary payer, it doesn’t just pay what wasn’t paid for by the primary insurance. It’s too complicated to type out while I’m on my phone, but it’s a pain. The only time TRICARE is a full secondary payer is TRICARE for LIFE, which is tied to Medicare.
4- Quite frankly her being busy is bull. Unless she is locked in a vault, all she needs to do is talk to her Shirt/1st Sgt and let them know she is having problems with TRICARE and DEERS. They will understand. And the longer she lets this go, the worse it can be, especially if your Stepkids info is not correct or updated I. DEERS.
Maxwell said:
@Van
She’s military and has been extremely busy until around 7/7:30pm for the past year. She’s asked but he said it wasnt his job to provide it and if she wants to question him then to go to court.
In strange that his response was that if she wants to question him then go to court. I would expect that his response would be if you want to question it then call the dr/hospital… if he were telling the truth.
@Eli
Some people are just high conflict.
Maxwell said:
@Van
She’s military and has been extremely busy until around 7/7:30pm for the past year. She’s asked but he said it wasnt his job to provide it and if she wants to question him then to go to court.
If he wants payment he can take her to court. That’s such a ridiculous stance on his part. I don’t see it going anywhere with a judge.
Also, was your insurance really not active? Seems like that’s information you would have ready access to.
@Van
It’s my wife’s personal insurance policy but given that she’s military her insurance is always active as long as she’s enlisted. She has 10 more years on her contract for example.