They can ask YOU about it. Then it’s up to you what to answer. They can’t call your doctor/pharmacy/insurance provider and get the info unless you give written permission.
I realized I might need to be more specific about what information I would have access to, especially about COVID.
Even between entities, we can’t provide any more info than is absolutely necessary. In the example I gave, I’m assuming the member told me they had a colonoscopy. If all they said was ‘I had a test at Mercy Hospital on 6/1/21 and they’re denying my claim’ then all I would say to the insurance provider is the same. And the insurance provider would only say ‘the claim was filed as diagnostic and not preventative’. I still wouldn’t know what it was for; the member would be the one to tell if they wanted me to know.
A co-worker and I worked at the same place in the past, so we know a lot of the same people. If I talked to Billy Bob about an issue with his prescriptions, I can’t hang up and tell her ‘hey, did you know Billy Bob takes Viagra?!?!?’. She doesn’t need to know, and I don’t care for a $250,000 fine and 10 years in prison.
As far as COVID, because our claims experience goes into calculating the premiums we charge the members, we have to know how much money was paid out for claims. The insurance providers DO know who they’ve paid COVID-related claims on, but they remove all identifying information before they give us the claims information. So we know we’ve X number of COVID-related claims, and we even know one person’s claims totaled about $500,000. But we will never know who that person is unless they do something like to write to us and say ‘Thank you for giving us such wonderful insurance! I was in the hospital with COVID and my claims were $500,000 but I only had to pay X amount of that!’.
Then we would know.
Thats exactly how we operated.
Thank you, great info! So if I wanted to keep my unvaccinated state to myself, my employer would never know. Now what if I tell my employer I’m vaccinated. Can they go to the medical facility or Insurance to find out if I really am?
Just looking at the various options. I suppose someone can say it’s none of your business, fire me and we will go to court. But most aren’t likely to do that. Or if one says that they lost their piece of paper. I suppose the employer can just say go get another one or don’t show up to work.
So it’s still not sounding good. Especially not with the Supreme Court Justices we have.