Despite laws mandating easier access to personal healthcare records, patients still experience roadblocks and systemic inefficiency.
When it was signed into law in 1996, the Health Insurance Portability and Accountability Act (HIPAA) aimed to give patients easier and more timely access to their medical records. However, a recent report from the Government Accountability Office (GAO) documents persistent hurdles patients still encounter in obtaining personal healthcare information from providers and insurers.
In many cases, resolving disputes over access to medical records have turned into lengthy battles. After reviewing 583 complaints it received regarding medical records access between February 2016 and June 2017, the GAO found that only seven complaints, or 1.2% of the total, were closed within 50 days. About 15%, or 90 cases, took 251 or more days to conclude.
Clearly, this shouldn’t be the case in a sector that’s seen such high levels of investment in emerging technology — especially if patients need this information to resolve insurance disputes. While understanding the larger findings of the GAO’s report are essential for understanding what patients — and your clients — may be going through on a daily basis, these systemic delays call for a greater push among everyone involved in the health insurance space to update their infrastructure and improve the user experience.
The GAO report highlights several cases in which patients were charged what it considered excessive amounts. In these instances, two patients paid $500 for a single request for their medical records, while another was asked to come up with $148 for a digital medical history. For people suffering from chronic medical conditions, the GAO report points out, copying costs could be higher because their records are more detailed and extensive.
Patient access to medical records may also be hindered due to a lack of education about their rights, the GAO notes. For example, many patients are unaware that they can file a formal complaint with Health and Human Services when denied access to their own medical information.
Providers, meanwhile, are experiencing infrastructural challenges when complying with these requests, often leading to delays. Medical records stored both on paper and in electronic files may not be properly organized, making it more difficult to provide concrete answers to patient inquiries. These inefficiencies make it more difficult to resolve claims, adding to mounting costs for your clients, providers, and insurers alike.
A Push for Better Access
The current Administration has begun an effort to make it easier for patients to have access to healthcare information that they need to make informed medical decisions and communicate with insurers on an equal footing. In March, the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma announced a new effort, “MyHealthEData,” which would allow patients to choose devices or digital apps where they can review their electronic health records (EHRs). Patients would also be able to download copies of their medical records and forward their health histories to chosen providers.For insurance agents, the GAO report underscores how imperative it is that you be fully informed and ready to help guide clients through an increasingly complex healthcare system. While clients may have many resources to turn to when it comes to answering health insurance questions, offering yourself as a resource will help establish a stronger working relationship. Whether you need to update them on changes happening within the health insurance space or provide them with advice on how to navigate disputes, clients will appreciate that you’re there for them when they need support.