Patient’s Guide to HIPAA – Basic Rights: C. Right to Request Confidential Communications (FAQ 25 – 28)
You are reading the Patient’s Guide to HIPAA, FAQ 25-28 .
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The HIPAA rule defines seven patient rights, one of them is a right to request confidential communications. This page includes all FAQs explaining this important right (FAQ 25-28.)
C. Right to Request Confidential Communications (FAQ 25 – 28)
FAQ 25: What is the Right to Receive a Confidential Communication?
You have the right to ask a health care provider to communicate with you by alternative means or at alternative locations. This means, for example, that you can ask your fertility clinic not to call you at work or to send you an email notification of an appointment. You could ask your psychiatrist not to leave a message about an appointment at your home telephone voice mail. You might also ask a specialized clinic not to send you a post card reminder of your appointment but to use a closed envelope. A provider must accommodate reasonable requests. We think that all of the examples in this paragraph are generally reasonable. We also think that that asking for written communications – including bills – to be in plain envelopes with no identification of the provider in the return address is also reasonable.
The right to receive a confidential communication is a real right that may be important to you. Not everyone will care or will care all the time. You may not object to a postcard from your dentist reminding you to make an appointment to have your teeth cleaned. However, many people would likely object to receiving a postcard informing them about a follow-up visit to a sexually-transmitted disease clinic.
The right to receive a confidential communication is important because a provider doesn’t need express permission to contact a patient at home or to leave a message on an answering machine. For a patient who doesn’t want others in his or her family or household to know about a form of treatment, then exercising the right to receive a confidential communication will be crucial. For some, this right may provide a vital privacy protection that will make the greatest difference to your life or wellbeing.
FAQ 26: How Do I Exercise the Right to Receive a Confidential Communication?
A provider may require you to make a written request to receive a confidential communication in writing. Read the notice of privacy practices to find out the local procedure. In a small office, an oral request may be sufficient. Still, if you orally tell the receptionist not to call you at your office, the doctor may not know about your request. A written request may be safer because it creates a formal record of the request. You should keep a copy of your written request.
The rule says that a provider must permit a patient to make a request, but it does not expressly say that the provider must respond at all, or in writing. However, a provider must agree to a reasonable request. You would be well advised to ask for a written acknowledgement and to save the acknowledgement. If you only receive an oral response, you might want to send a written confirmation to the provider, and keep a copy of your confirmation. The written confirmation should summarize the request and identify the person who agreed to comply. Ask the provider to respond if the summary is incorrect.
You do not have to tell the provider why you made the request. Indeed, the rule expressly prohibits a provider from requiring an explanation as a condition of fulfilling the request. However, the rule does not prohibit the provider from asking for you reason. You don’t have to disclose your reason if you don’t want to.
FAQ 27: Does the Right to Receive a Confidential Communication Apply to Health Plans?
Yes, but the rule is a bit different. To make a request to a health plan, the individual must clearly state that the disclosure of all or part of the information could endanger the patient. The plan may require that a request contain a statement that disclosure could endanger the patient. The plan can demand a written request.
It is not apparent, however, that the patient must identify what the harm is. The statement that disclosure could endanger the patient seems to be enough. Perhaps the most likely example of endangerment is a threat of domestic violence. A battered spouse may not want information about her location or activities to be accessible by her batterer.
We can’t be sure about everything that might constitute endangerment. We suggest taking the position that it is up to the patient to decide what it means. If you say that disclosure could be potentially endangering or merely embarrassing, that’s enough to convince us. If a disclosure to the wrong person might persuade you to stop seeking treatment, we would argue that also constitutes endangerment. We can’t predict how plans will respond, but we emphasize that plans must accommodate reasonable requests. Asking to send mail to an alternate address (physical or email) strikes us as reasonable. Asking for phone calls only to your cell phone and not to your home phone also strikes us as reasonable. Asking for messages to be sent by carrier pigeon will not be viewed as reasonable by anyone.
FAQ 28: Are There Any Other Requirements for the Right to Receive a Confidential Communication?
A plan or provider can condition the accommodation on the patient providing an alternative address or means of contact for information about how payment will be handled. This means that you can’t ask someone to send all bills to the White House unless you are the President.
There’s an exception for emergencies. No matter what restriction a covered entity agreed to, it can ignore the restriction in case the information is needed to provide emergency treatment. Fair enough.
Roadmap: Patient’s Guide to HIPPA: Part 2: Basic Patient Rights: C. Right to Request Confidential Communications (FAQ 25 – 28)