Health insurance sent my PHI to a family member. What to do?
May 8, 2023 1:48 PM   Subscribe

Should I report this? How does this happen?

Hello, I recently enrolled in Aetna with my employer back in March. I had Aetna years ago, maybe like 4-5 years ago. However, I enrolled under my employer's plan this March. I got a call from my mother who opened my mail (it came to her house - though addressed to me) from Aetna, with ALLLLL my information about an upcoming procedure, my health insurance info, my doctor, etc. It was for pre-certification. I don't want my mom knowing these details. I don't share them for a reason, and she will find her way to try and take over my medical care.

I checked the hospital. They don't have her address on file. I checked my employer and there is nothing with her address on file. She is not an emergency contact. I checked Aetna. They said my address is with my employer. Went back to the employer. Employer says yes, they can see that Aetna has my mom's address, but that this was not given by the employer as they do not share that kind of information with health insurance plan and said Aetna would need to be contacted. I contacted Aetna, they have nothing on file that it was sent to my mom, though I'm looking at the letter right now. I'm on hold with another department now. My only thought is that years ago (4-5 years) when I had Aetna, I might have had her down as an emergency contact, but I have not used my mom's address for medical billing since 2016.

This feels a bit wild. What can I do in this situation to make sure it doesn't happen again? Other than trying to figure out how to change my address. How does this happen? Can/should I report this somewhere?
posted by socky bottoms to Law & Government (9 answers total)
You do not mention where you live, but Aetna presumes somewhere in the United States, so you have a few options to report a HIPAA violation. HIPAA is a set of regulations intended to manage how health data are shared and with whom. Your situation does not necessarily guarantee that a violation occurred that meets legal guidelines, but if one did, this might help with further legal action if your jurisdiction allows recovering damages.
posted by They sucked his brains out! at 1:54 PM on May 8 [3 favorites]

While it is weird that it went to her address, it is not Aetna's fault that your mother opened mail addressed to you. They addressed it to the appropriate recipient and sent it to the address they had on file.
posted by hepta at 1:59 PM on May 8 [19 favorites]

sent it to the address they had on file.

Except that Aetna is saying that they didn't send it to the OPs mom.

I would report a HIPAA violation and let Aetna know that you never want this to ever happen again. Give them a chance to purge your mother's address completely from your account and ask for a full printed copy of your account information afterwards.
posted by Tell Me No Lies at 2:26 PM on May 8 [3 favorites]

I do benefits administration for my employer and we use Aetna. If an employee shared that this happened to them, and I confirmed it wasn't because of our employment records, and the employee confirmed that they had contacted Aetna about it and been directed back to me, I would reach out to my client manager at Aetna. I would ask them very nicely as a favor (but heavily leaning to the potential privacy violation) to please put extra attention onto your member profile and have a specialist reach out to you directly.

While the problem isn't something that I (as the employer) could fix, what you've presented here sounds like enough of a member customer service issue making our benefit package look bad that I could ask for it to have special handling. You can take this as an ask back to your HR.
posted by phunniemee at 2:31 PM on May 8 [25 favorites]

Also a note on semantics, don't say the problem is that this was "sent to your mom" because technically it wasn't. Your key phrases are going to be:

"sent to an address at which I no longer reside"
"that has not been my legal address in x years"
and "completely remove this address from my account"

Of course it's just as much a privacy violation for this to get sent to you at your mom's address as it is to send it to Bobby Someguy at your Random Old Apartment, but many people hear a family member and downgrade the importance of the ask.
posted by phunniemee at 2:48 PM on May 8 [49 favorites]

One little small action you can take is to put a mail forwarding form in for yourself at your mom's address. I would do that asap. It's free at the post office or like $2 online. I cannot think of why you shouldn't do that regardless of all other actions.

As for the actual question, we get our Healthcare thru a broker. And they deal with benefits admin type people. We'd be getting our broker on the horn post haste if this happened. Mail sent to the wrong address (not your mom's.... Just plain wrong per se) is a big deal they should be paying attention to and I feel like the middle ware folks will care and have better access to correct it.
posted by chasles at 3:47 PM on May 8 [8 favorites]

Did your mom have Aetna insurance before 2016, when you were a dependent/under 26 years of age? Weird linkage might pre-date your work history and coverage.
posted by Iris Gambol at 6:45 PM on May 8 [2 favorites]

Have your mom send photos of the envelope if you haven’t collected these details yet. With your mom, it’s about the boundaries. Unless you asked her to open the envelope, it remains sealed. I text a photo of mail to my adult children and help it along-if it’s small enough (sometimes it’s a holiday card) I tuck it in snail mail and away it goes, unopened!

Dealing with anything she read-she needs to literally forget anything she saw. Don’t reward her behavior if she is likely to try taking over your healthcare plans.
posted by childofTethys at 4:44 AM on May 9

Yes, I would report this; it's appallingly sloppy. I've experienced sloppy database errors from health insurers, and it's just not acceptable.
posted by theora55 at 9:44 AM on May 9

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