Individual Health Insurance Plans example essay topic

11 Aug. 03 Health Insurance Portability and Accountability Act of 1996 In an effort to create and enforce strict guidelines on how all health care providers communicate, the Health Insurance Portability and Accountability Act of 1996 was created. Although the legislation is necessary because of increasing use of electronic communication and the need to safeguard patients? privacy, the costs of implementing the Health Insurance Portability and Accountability Act of 1996 have been astronomical. There are many questions that people have about the Health Insurance Portability and Accountability Act of 1996: What is it, how did we get it, what effects has it had on different health care entities, and lastly, how have we been affected by the Health Insurance Portability and Accountability Act of 1996 at this point? There has been a great deal of confusion as to what the Health Insurance Portability and Accountability Act of 1996 really is. In the health care industry, it has a different connotation than in the private sector. If one is employed in a health care related business, the Health Insurance Portability and Accountability Act of 1996 makes for more paper work, more federal regulation, and, at times, difficulty to treat a patient because one cannot get any information from a third party.

In the private sector the Health Insurance Portability and Accountability Act of 1996 creates rules and regulations that limit how health related conditions can be discussed. It also creates safeguards for health and life insurance (HIPAA Primer). The official government description of the Health Insurance Portability and Accountability Act of 1996, which was signed into law on August 21, 1996, is to help combat waste, fraud, abuse, improve portability of heath insurance coverage, and simplify administration of heath care (Hep-C Alert). The Health Insurance Portability and Accountability Act of 1996 also calls for the standardization of electronic patient health information, and administrative and financial data.

Unique health identification codes for individuals, employers, health plans, and health care providers are to be used. Security standards protect the confidentiality and integrity of "individually identifiable health information", past, present, or future (HIPAA Primer). The Health Insurance Portability and Accountability Act of 1996 also increased the deductible of health insurance for the self-employed, making medical savings accounts available to small employers, simplifying health claims and billing forms. It clarifies tax treatment of long-term care insurance and provides significant new tools to combat health care fraud and abuse. The Health Insurance Portability and Accountability Act of 1996 goes on to limit preexisting conditions exclusions, and guarantees the availability and renew ability of health insurance. It also prohibits health plans from discriminating against people based on health status (Implementation).

For the general public, The Health Insurance Portability and Accountability Act of 1996 helps with insurance coverage and limits what is considered preexisting conditions. It has established many guidelines that must be followed. Some of these guidelines include having at least eighteen months of continuous creditable coverage, and not being eligible for coverage under a group health plan including spouse, Medicare or Medicaid (HIPAA). When discussing the Health Insurance Portability and Accountability Act of 1996, there are very specific terms that are used. Once one knows what the Health Insurance Portability and Accountability Act of 1996 is, it helps to understand several related terms. "Electronic Health Transactions" refers to information that is transmitted in any electronic form.

This includes health claims, health plans, eligibility, enrollment and dis enrollment, payments for care and health plan premiums, claims, injury reports, coordination of benefits, and related transactions (HIPAA Primer). "Electronic Data Interchange" is personal information that is transferred via computer. "Protected Health Information" is information about one's health that is not exchangeable between health care parties because of its content (HIPAA). Who had time to come up with such a difficult and complex legislation? This is a question that has been raised by many. For many, it would appear that our senators had nothing to do.

But, to take the time to learn and understand the Health Insurance Portability and Accountability Act of 1996 may change one's mind. Many people would be very surprised to learn that the Health Insurance Portability and Accountability Act of 1996 movement dates back to 1975. In 1975, a group of health care providers and payers was formed known as "National Uniform Billing Committee". This group worked together to standardize hospital claim forms. The group worked until 1982 to reach consensus on what was to be known as the UB-82 claim, the industry's first standard claim form. By 1988, sixty percent of all hospitals were submitting electronic claims in the UB-82 format.

Then twenty-one years later, with the enactment of the Administrative Simplification Provision which included mandated standard transactions, the foundation for the Health Insurance Portability and Accountability Act of 1996 was born (How). On August 21, 1996, the Health Insurance Portability and Accountability Act of 1996 was signed into law. States were given several options on how to implement these plans. All health care plans were required to provide all of their customers with certificates of creditable coverage. The Health Insurance Portability and Accountability Act of 1996 regulations required states to submit to Health Care Finance Administration, by April 1, 1997, a notice of intent to implement the statutes of the law. After passage there were many areas that had not been addressed under the Health Insurance Portability and Accountability Act of 1996.

Adjustments had to be made to several preexisting acts, such as Mental Health Parity Act and the Newborn's and Mothers Protection Act of 1996. The changes were written in and published by June 26, 1997 (Implementation). After many hearings between the Health Insurance Portability and Accountability Act of 1996 committee and the House Ways and Means Committee, the deadline for having the Health Insurance Portability and Accountability Act of 1996 in effect was set for April 14, 2003. With this deadline set, all states had to have their implementation plans submitted to the Health Care Financing Administration (Health Insurance).

Now that the Health Insurance Portability and Accountability Act of 1996 has been implemented, how has it changed the way business is conducted within the healthcare industry? When one goes to his or her physician's office, one will notice that he or she is required to sign several forms that will allow the office personnel to do a number of things. One of the first is permission to call the patient's name out when the doctor is ready for the patient to come to the examination room. Even with signing this form, the patient's first name is all that can be used. Another release form to be signed is to allow the patient's or designated person's test results or other messages left for them on the telephone answering machine (Lade). There are a large number of changes that had to be made in many offices and workspaces.

All visible medical records had to be relabeled with no personal information exposed. The office has to implement a plan that gives each patient a personal identification number. The only people who have access to these codes are direct care workers. These codes are to be kept secure behind two locked doors, and only given to direct care givers. The Health Insurance Portability and Accountability Act of 1996 also states that one cannot keep patient information out on a desk when it is not monitored. This at times makes it difficult to keep the flow of work going.

When one leaves the work area, everything must be locked in their desk. Along with this, one cannot identify himself or herself as a healthcare provider when making a telephone call to a patient's home or business. This makes it very difficult to communicate to a patient or family member about important issues. It also creates a higher volume of telephone calls into the office, which can hamper care (Root). Like physician's offices, health insurance companies are not able to obtain information as easily. The Health Insurance Portability and Accountability Act of 1996 was enacted to help protect personal health information, and increase the amount of insurance a person can obtain.

Under the Health Insurance Portability and Accountability Act of 1996, one might be able to buy an individual health plan without the threat of exclusion for preexisting conditions (HIPAA). The Health Insurance Portability and Accountability Act of 1996 sets the standards on what is considered a preexisting condition. Another way the Health Insurance Portability and Accountability Act of 1996 affects health insurance is that it limits the time period for preexisting medical conditions or private plans. It states that the health insurance plan must cover an individual after twelve months.

The way it reads is, "If, at the time you change jobs, you already have had twelve months of continuous health coverage, without a break in coverage of sixty-three days or more, you will not have to start over with a new twelve month exclusion for any preexisting conditions" (Hep-C Alert). Not all preexisting conditions are excluded. Several states have been able to set standards for their individual state. The Health Insurance Portability and Accountability Act of 1996 also defines "credible coverage" to insurance companies as coverage such as group health plans, Consolidated Omnibus Budget Reconciliation Act (COBRA), Health Management Systems (HMS), Medicaid, Medicare, individual health insurance plans, or insurance coverage under a spouse's plan. The Health Insurance Portability and Accountability Act of 1996 also limits the amount of information that can be released to insurance plans.

It reduces how far back an insurance company can research on one's health history (Health Insurance). What will happen if the Health Insurance Portability and Accountability Act of 1996 guidelines are not followed? The government has set some very serious and stiff penalties for those who do not adhere to these the guidelines. To assure the accountability of those who had access to personal health information (PHI), the United States Congress required the imposition of civil and criminal penalties for any entity or person that uses personal health information improperly (Schroeder). Under the Health Insurance Portability and Accountability Act of 1996 guidelines, one could be fined up to $25,000 for multiple violation of the same standard in a calendar year. Fines up to $250,000 and / or up to ten years imprisonment for knowing misuse of individually identifiable health information (HIPAA Primer).

Now that all compliance deadlines have passed, the government has started performing compliance inspection and is enforcing penalties. Although the Health Insurance Portability and Accountability Act of 1996 has been in committee for fifteen years, it was not required to be in place until April 14, 2003. Since it has only been enforced for less than five months, we are unable to see how it will affect health care in the future. How has it affected health care thus far?

No longer are patients called by their name when they go to the doctor's office. Most of the time the patient is greeted with a simple "Hello". It has made doctors? offices and pharmacies change from a very personable atmosphere to a more sterile atmosphere. Patients will no longer receive telephone calls to remind them of an appointment. On the plus side, many people are able to get health coverage that they were unable to obtain (Sowa). Many patients will also notice the increased cost of a visit to the doctor's office, or an increase in the insurance deductible.

This has come about because of the cost of putting the Health Insurance Portability and Accountability Act of 1996 into effect. In 1992, Workgroup for Electronic Data Interchange (WEDI), a consulting firm, compiled data and established that between 5.3 billion dollars and 17.3 billion dollars had been spent to come into compliance (Health Insurance). The part that many people have not seen and that contributes to the cost of implementation is the massive number of hours spent training employees in the Health Insurance Portability and Accountability Act of 1996 guidelines (Sowa). Most offices have had to purchase special software for computers and incur attorney fee's to insure that policy and procedures meet federal guidelines (Hep-C Alert). According to Stephanie Reel, Chief Information Officer and vice provost for Information Technology at Johns Hopkins University in Baltimore, "Most of what the Health Insurance Portability and Accountability Act of 1996 expects is good common sense management, but it does introduce additional levels of complexity" (Mach lis).

The Health Insurance Portability and Accountability Act of 1996 has created much anxiety since its conception. It has not been in place long enough to see if it has helped keep personal health information from being misused. It has changed how we communicate in the health care industry. But the bottom line is that it has made drastic changes in communication in health care..