How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Phillips Esq. Your Own Question
Phillips Esq.
Phillips Esq., Attorney-at-Law
Category: Family Law
Satisfied Customers: 17537
Experience:  B.A.; M.B.A.; J.D.
16551887
Type Your Family Law Question Here...
Phillips Esq. is online now
A new question is answered every 9 seconds

I have a question about health insurance and PPA as related

Customer Question

I have a question about health insurance and HIPPA as related to divorce/child custody in Washington DC Background-I am divorced and share legal custody of my two minor children with my ex. Ex husband carries the kids on his medical insurance. Ex husband's
new wife (kid's step mother) carries the kids on her dental insurance. I filled out and sent in to the medical and dental insurance companies a form authorizing me as a person representative for my children and giving me access to their claim information.
I also sent them a copy of the custody agreement which says that I have legal custody and which also says that I am entitled to full access to all insurance info related to the kids. The insurance companies are now saying that they cannot give me any information
related to my kids because I am not the policy holder or carried on the policy. They cited HIPPA and said that I am not authorized to fill out the personal representative form because I am not on the policy. (There is nothing on the form indicating that I
need to the policy holder in order to fill out the form.) They also indicated that the step-mother/my ex had contacted them to block my access to the kid's information. (Please note that I have never tried to get information about claims for my ex/the step-mother.)
1-Am I entitled to my children's insurance claim information under HIPPA if I am not the policy holder or carried on the policy? 2-If yes, what steps should I take to compel the insurance company to provide me this information? Thank you.
Submitted: 1 year ago.
Category: Family Law
Expert:  Samuel II replied 1 year ago.

Hello

This is Samuel and I will discuss this and provide you information in this regard

The insurance company is doing what is legal. However, the step-mother is not and the Father should be directing her to release her block on the information so you can get the information that as the parent are entitled to.

I suggest you can contact the Father - generally a letter send certified mail with a return receipt requested is the way to communicate in such a situation so you have proof you made contact - and you need to tell him that she has a block on you obtaining the information and that it is a contempt of court. That if she does not release the block, you will file a contempt/show cause against him and you will also request the court make him pay for your legal fees in this regard since it is his fault the matter will need to go to court. That is why the letter Mailed Certified with the RRR is important. That way you can show the court that you have tried to settle this out of court and the only reason it is now before the court is because he would not assist.

Customer: replied 1 year ago.
Thank you-I appreciate your response but I have a family lawyer and know all about filing for contempt. Since doing that would start WW3 and this issue comes up repeatedly, I am specifically interested in learning the finer points of the HIPPA law as it relates to insurance companies and accessing the information of a minor/dependent.
Expert:  Samuel II replied 1 year ago.
Hello
If you have a custody Order and it grants you shared or sole LEGAL custody - not to be confused with PHYSICAL custody, then I suggest you file a Complaint against the medical office for not allowing you the information.
Keep in mind that LEGAL custody is needed. That means that neither parent should be precluded from having medical information. If you only share PHYSICAL custody and the other parent has Sole LEGAL then you would not be entitled to the information, without the consent of that parent. However, a step parent has no right to enforce anything, unless the parent with the SOLE LEGAL custody has granted that permission.
And since you state that you SHARE LEGAL custody, I suggest that you will need to file the complaint against the medical staff. You can contact the physician and tell them that you do not want to file that complaint, but you have a Court Ordered Shared LEGAL custody and they need to allow the information and if they do not you will file the complaint.
But you state this is not about the facility, that you need Insurance information. And I suggest they do not need to give you any insurance information. That is something the Parent who carries it should provide. And the Insurance company is only responsible to their client. And in that regard the Contempt is the only solution.
Customer: replied 1 year ago.
I have no issues with the medical providers. HIPPA clearly allows me to talk with them in this case. However, the insurance companies continue citing HIPPA as their reason for not providing me with EOBs even after I have provided them with copies of my custody agreement documenting that I have shared legal custody (and a right to communicate with them) and proof of my identity. Because of that, I would like to better understand the finer points and specifics of HIPPA law as it relates to access to information of a dependent from an insurance company so that I can be better informed in my future letters to them and discussions with them.
Expert:  Samuel II replied 1 year ago.

Thank you

I apologize but I do not feel I can provide you any further information.

I will Opt Out and allow another professional here to assist. Please DO NOT RATE any of my information at this time and your deposit will stay in tact, your question will go back into the main list and another will be with you shortly.

I apologize for any inconvenience.

Thanks for your patience.

Expert:  Phillips Esq. replied 1 year ago.
Hello: This is PhillipsEsq. I am a licensed Attorney and I will be assisting you today.
Your last post:
I have no issues with the medical providers. HIPPA clearly allows me to talk with them in this case. However, the insurance companies continue citing HIPPA as their reason for not providing me with EOBs even after I have provided them with copies of my custody agreement documenting that I have shared legal custody (and a right to communicate with them) and proof of my identity. Because of that, I would like to better understand the finer points and specifics of HIPPA law as it relates to access to information of a dependent from an insurance company so that I can be better informed in my future letters to them and discussions with them.
Response: HIPAA is not at issue here because as a parent you are entitled to your child's information if you have legal custody. However, the insurance company has no legal duty to release the information to you without the authorization of the policy holder or the Court. So, the issue is with your ex and not with the insurance company. Even if you are the parent, the insurance company cannot give you information on someone else's policy without the authorization of the policy holder.
Also, this information that you are requesting from the insurance company should be requested from your ex. That is the proper way to do it. Then if your ex refuses to provide the information to you, you need to take the matter to Court.
Customer: replied 1 year ago.
I appreciate your response but again I am not looking for a family law response here-I have that angle well covered. I specifically posted this question to understand the specifics of the HIPPA law and I apologize if that wasn't clear. HIPPA is an issue because the insurance companies are citing HIPPA as the reason they cannot talk to me.I believe I have found my answer from another source. Last night a friend connected me with someone they know who works at the federal government in Health and Human Services. I learned that,
-HIPPA law section 45 CFR 164.502(g) specifically states that parents with legal custody (joint or sole) are considered a minor’s personal representative and are authorized to act in place of the minor in all dealings with a covered entity. An insurance company is included in the definition of a covered entity.
-In addition, many state laws also give custodial parents the right to interact with insurance companies. For example, Virginia Code Title 38.2-3401.2, C. says “Any insurer, health services plan, or health maintenance organization providing coverage to the child of a noncustodial parent shall (i) provide to the custodial parent, upon request, any information that is necessary to obtain benefits for such child under such coverage; (ii) permit the custodial parent, or the provider of health services if approved by the custodial parent, to submit claims for services without the approval of the noncustodial parent; and (iii) make payment on claims submitted pursuant to clause (ii) directly to such custodial parent, provider, or the Department of Medical Assistance Services.” The governing state law is determined by the state the insurance policy is incorporated in, and these provisions are often described in insurance laws, not the family court laws.

Related Family Law Questions