Earlier this year, the Department of Health and Human Services released a request for information seeking public input on how the Health Insurance Portability and Accountability Act Privacy Rule could be modified to further promote “coordinated, value-based health care,” while preserving the privacy and security of an individual’s protected health information. Among the issues HHS is considering is how to improve the response time by which health providers respond to a patient’s medical records request. Per federal regulation, health providers are required to respond to a patient’s request for medical records within 30 days. However, compliance does not appear to be vigorously enforced and there is often a significant delay in the patient gaining access to critical health care records. Anyone can file a HIPAA violation complaint with the Office for Civil Rights (OCR). Complaints must be filed within 180 days of knowing that the act or omission complained of occurred, and can be submitted online.
During NAIFA’s 2018 NAIFA National Advocacy Meeting, NAIFA members acknowledged difficulty in their clients accessing medical records for insurance-related underwriting. NAIFA surveyed its members to discern how their clients are affected by a medical provider’s lack of timely response to a records request. NAIFA members reported that providers will claim they did not receive a patient’s request and third-party entities that copy the records will not honor requests that deviate from the form’s instructions even in very minor and insignificant ways. As a result, NAIFA members note that it often takes months for records to arrive. Since medical records are often a necessary element for the underwriting of life or health insurance policy, the unnecessary delay in responding to the patient’s records request needlessly prolongs the client’s policy application. In some cases, these delays have resulted in changes to the client’s underwriting status, delayed the issue of a policy, and even denied applications. NAIFA submitted a comment letter to HHS noting the concerns expressed by advisors.
As this year’s National Advocacy Meeting is about to convene, some NAIFA state chapters are exploring legislation to impose enforcement penalties for non-compliance. While the statutes and regulations in most states mirror the required response time outlined in federal regulation, only ten states impose and enforce penalties on provides for non-compliance. These states subject the provider to fines and/or permit the patient to file a lawsuit against the provider.
NAIFA sides with patients and their right to obtain their health care records, and compliance with federal and state rules on this matter should be enforced.
