Part I: Privacy Rule Summary
One of the fundamental sections of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is the Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”). The Privacy Rule has two main roles, which, to some extent conflict, towards which it maintains a balance. The first role is to ensure ease of flow of information in order to enable the best level of care for every patient and ease of decision-making for healthcare professionals. The flow of information also includes a right by the patient to access medical information, obtain for a copy of the same, and where necessary, request for corrections on the records. The second role involves the protection of privileged patient data by eliminating any unauthorized access and limiting authorization of access based on absolute necessity. Adherence to the Privacy Rule requires healthcare professionals to strike a circumspect balance between the two roles outlined above.
The Privacy Rule covers all the important players in the healthcare industry. These players include healthcare providers such as hospitals, healthcare plans who assist in paying for medical services such as insurance and health care clearinghouses. These players should protect information about a patient’s past, present or envisaged future treatment, information about the patient’s condition and finally, information about the cost of treatment.
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In line with the balancing act outlined above, this information should be available to the healthcare professionals who need to utilize it for patient care. Contemporaneously, the same information should be protected from any unauthorized access. Further, even those professionals who qualify for access should only get access that is limited to the extent of usage in order to limit the potential for breach of privacy. However, there are two main exceptions to the privacy rule. The first exemption, as outlined above entails providing patient information to the patient or the patient’s representatives, subject to regulatory limitations. The second exemption involves the provision of information for a formal government investigation, once again subject to specific regulatory limitations.
Part II: Denial Letter
(Organization’s Letter Head)
Date
Patient Name
Street Address 1
City, State Zip Code
Re: Denial of Request To Access Health Information
Dear Patient
We are in receipt of your request for information regarding your medical records as held by this organization. We wish to inform you that after carefully reviewing the said letter and applicable laws, rules, and regulations, we are unable to comply with your request for the following reasons.
The request did not correspond with the set format; hence we were not able to identify you as the qualified recipient of the information requested. We kindly request you to liaise with the customer relations department for the right format of application.
Further, for some of the requested information, we currently have obligations to other pertinent parties, which obligation does not allow us to share that information with you now. We shall inform you as soon as we are in a position to reveal such information.
On the other hand, there was some information included on your request whose provision would require us to divulge to you privileged information about another patient. We wish to inform you that we are not in a position to divulge any information touching in another patient without the patient's express permission.
Finally, we also noticed that some of the information requested involves a dependent who, according to our records has already attained the age of adulthood as provided by applicable laws. Kindly note that we are not in a position to provide such information without the express permission of that patient in spite of the dependency.
We also wish to inform you that it is within your right to ask for a review of any of the decisions communicated through this letter. Such an appeal process is available through our offices and through the office of the Secretary of the United States Department of Health and Human Services. We assure you that there will be no retaliation for such an appeal.
Yours Truly
________________
For, ____________
