Does my employer know when I visit a doctor?
October 8, 2019 12:19 AM   Subscribe

What it says on the tin, basically. This is a family company, I pay for PPO health insurance offered by the company with a major insurer. Does my boss and/or benefits manager know if I visit a doctor's office, in some sort of monthly claims statement or something? I have been fibbing about a medical issue. (Don't be me.)
posted by anonymous to Work & Money (6 answers total) 1 user marked this as a favorite
Normally no - the company would just get a bill in aggregate for the cost of cover + some overall usage statistics. If the company is small and usage is sparse, it may be possible to infer something from that data but someone in the company would have to specifically do that analysis and even then it would be circumstantial.
posted by crocomancer at 1:35 AM on October 8, 2019

Hi I manage HR for a small company. The answer is maybe. You do not mention country but I’m assuming USA.

Out employees have two types of health plan: standard health insurance through a big company, and reimbursement of deductible from a small local HR services firm. Basically we pay for a medium cost health plan but then reimburse 100% of deductibles by paying the employees back directly.

I never see any details from the big insurance company. HIPAA rules are very strict.

I do get a little info from the reimbursement. I see an employee name and dollar amount. It could be anyone in the family if the employee has a family plan. I get no info on provider or treatment.

If your employer self-insures they might seem more. That is a very rare and unlikely occurrence.
posted by sol at 3:04 AM on October 8, 2019

No, and the number of employees who ask me questions like I know their personal medical history is super weird. I have to tell people no, there's no way I could possibly know what your gastroenterologist billed on your last visit at least once a month.

We do use a 3rd party service to help employees with their specific detailed questions about claims, etc. We will very occasionally get an email from them if something gets escalated and an employee is mad, and in those cases they always 1) ask the employee for consent to alert us, and 2) it's framed as hey, your insurance is not good about this thing, take this issue to the table when you renegotiate your prices OR your remote employee 100 miles from any major city in MO isn't able to find a covered rheumatologist in their area FYI.
posted by phunniemee at 6:14 AM on October 8, 2019 [1 favorite]

If your employer self-insures they might seem more. That is a very rare and unlikely occurrence.

To augment that: Many larger companies do self-insure but they outsource the plan administration, so the HIPAA shield applies. Conceivably someone like a health insurance company not only self-insures but self-administers, but even there HIPAA applies and should shield the information from HR or other execs.
posted by beagle at 8:12 AM on October 8, 2019

if You told any of your coworkers or if they had suspicions it’s much more likely information would come from that than from the medical practitioner you may or may not have visited.
posted by one4themoment at 4:17 PM on October 8, 2019

in the US med records are VERY private federal law
posted by patnok at 4:12 PM on October 9, 2019

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