Blue Cross Blue Shield Health Insurance

Privacy issues tangle up the Blues

Blue Cross Blue Shield of North Dakota must be able to convince Mid Dakota Clinic of Bismarck that sharing patient information in a chronic disease initiative does not violate patient privacy laws. Failing to do so means that Mid Dakota cannot ethically participate.

In conflict are the privacy standards set up by the federal Health Insurance Portability and Accountability Act of 1996 and the desire to control the cost of health care. Privacy versus increased health care costs.

Payments to Mid Dakota and other providers also are at issue. Blue Cross Blue Shield uses fee and rate incentives to leverage participation.

The Blues have been able to convince doctors and providers representing 75 percent of the insurer's patient members that HIPAA standards are met in the initiative. Negotiations are continuing between Mid Dakota and Blue Cross Blue Shield, which represents a majority of North Dakotans who have health insurance.

In the initiative, as described in a Blue Cross Blue Shield information chart, a doctor meets with a patient and collects information. Using secure logins, data is run through a third-party database. The system identifies "necessary care and overdue preventive screenings," which would be transmitted to the doctor who would have that information to help proscribe treatment, all in the space of that same appointment.

The rub, for Mid Dakota, is providing patient information to a third party and providing all patient information, not just Blue Cross Blue Shield patient information. Is it done, Mid Dakota asks, within the parameters of HIPAA?

In thinking about this, consider whether an individual's banking or credit card information would meet that standard. These are computer and Internet software and hardware issues. Are there enough protections in the system to ensure patient medical information remains private?

If all patients gave their consent to participate, this would be a non-issue. Unfortunately, patients opting out would skew the numbers.

Health Insurance: How Is Blue Cross Blue Shield Related To Blue ...

Blue Cross Blue Shield are independent, locally owned health care providers. You’ll find them in almost every state, and they belong to an association, but there is no parent corporation. Blue Choice is one of the plans offered. Blue Care Network could be as well. I am enrolled in Blue Choice offered by Excellus Blue Cross in western NY. Blue Choice elsewhere is probably similar but the coverages won’t be the same everywhere you go, nor the costs.

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