Will they know that I'm sick?

January 11, 2009 10:25 PM

What information does my workplace receive about claims on my health insurance?

I would like to see a mental health professional but I'm concerned that it may haunt me in my career. What information about the doctors I see will be available to HR? I work at a large bank if that makes any difference.

Thanks!

posted by anonymous to work & money (6 comments total)

Most employers enter into contracts with insurance companies to provide health insurance. A few employers are "self-insured," but even those companies generally hire insurance companies as administrators of the benefits. Under various laws, including but not limited to HIPAA, as well as standard practice, information about individual claims is not transmitted from the insurance company to the employer. (And, honestly, a employee's claim for outpatient mental health services and medications is so generic, so ordinary as a claim, so pap smear and cholesterol, it just doesn't create any ripple whatsoever.)

When employers get their premium quote at the end of the year, they may hear that the claims of their employee group are considered "high," or average, or whatever, as part of the explanation for the premium. But they don't receive individual claims information.

A few employers -- health care providers who are also employers -- have more of their employee health care and related paperwork in house. HIPAA requires that health care information not be disclosed from the health side to the employer side, and these employers tend to have spent a lot of money on computer programs that track any person accessing medical records. Nevertheless, there is some (additional) risk of some disclosures with these employers.
posted by ClaudiaCenter at 12:07 AM on January 12 [3 favorites]

Doctor/patient confidentiality covers you from having your insurance know what you're being treated for. As ClaudiaCenter mentions, they may know that you've filed more claims than the guy in the next cubicle, but they won't know why. And really, it matters way more to the insurance company than it does to HR.

If they ask, just tell them flat out that you're taking care of your health and that's between you and your doctor. Period.
posted by grapefruitmoon at 3:45 AM on January 12

ClaudiaCenter's answer is very good. If I could just add a couple of points:

-A normal large self-insured employer may, in fact, have quite detailed information about your medical claims as they are the payer and allowed to see whatever they want. HIPAA (as ClaudiaCenter mentions) requires that any insurance-like activities are kept separate from normal HR activities, and that the claim info be treated as PHI. Practically, because of the demands of complying with HIPAA, this means that most self-insured employers don't want anything with a name attached to it from the administrator. That is, it's easier for the employer to just never see any PHI than to worry about all of the administrative safeguards. Your employer, though, could see whatever it wants if it's self-insured, but it has to treat the information as PHI.

-Really, the only time anyone's interested in specific claims are when they're for very large dollar amounts. Every employer/health plan has different triggers, but nobody's ever going to pay attention if it's less than $25K. Even if it were more than $25K, nothing would be done to identify you and term you based on that info. They're just interested generally in how the plan's running.
posted by MarkAnd at 5:13 AM on January 12 [1 favorite]

Doctor/patient confidentiality covers you from having your insurance know what you're being treated for.

Oh, and I think I understand what you're saying here, but it's a little unclear. The insurer has an ICD-9 code, but they don't have any more specific information. So they have a bucket (sometimes quite a specific bucket), but no further info.
posted by MarkAnd at 5:20 AM on January 12

MarkAnd's answer is very good, especially on the first point. I'd like to add that, in general, detailed reporting is generally custom and done at an additional cost. While I can't speak for all insurance carriers, in general, companies are much more likely to get a generic large claimant report and not go much beyond this. Additionally, the insurance companies require that stringent confidentiality agreements be signed before any PHI gets produced.

Honestly, I wouldn't worry about it. Just do what you gotta do and take care of your health.
posted by smalls at 9:04 AM on January 12

I'll throw in just my personal experience as an HR/Benefits person. The reports I received from the Insurance carrier (NOT self-insured) only told me what claims had been submitted but I didn't get a name associated with it.

Not sure what your definition of large is but my company had about 1000 employees and all I ever even noticed on the reports were really big claims ($10,000+, in a good month maybe the $5,000+ claims). As for an individual going to a shrink once a week? Not even a blip on my radar, and I wouldn't have known who they were anyway unless I found out through other means. My company was very open and friendly so I usually knew from the employees themselves but never from the carrier.
posted by magnetsphere at 9:15 AM on January 12