Outcome of Union - HIPAA Issue

In September I raised the issue of whether the primary responsibility of Union Health Plan Commissioners is the protection of the Plan or the Union members? With LineCo (the Union), the Plan requires completion of a course of treatment in order for any benefits to be paid out.

The case involved a member who had completed inpatient treatment near the end of one month and was scheduled for outpatient follow-up in the subsequent month. The Plan benefits terminated at the end of the first month as the result of a layoff. The patient postponed the outpatient until he had saved the cash to pay for it. The Union denied the inpatient claim despite the patient having complied with all other DC plans. Our challenge was that the Union was not entitled to Protected Information after their Plan no longer covered the patient. The interpretation of the lawyers was that a request for information after coverage terminates is not unreasonable for a month or two, but that a protracted requirement could be a violation of HIPAA.