First some background,
My 17 yr niece lives with us and her dad carriers the insurance. We live in MN and he lives in NM. My sister had her address sealed by the courts so her dad wouldn't know exactly where my sister and niece lived (at the time my niece lived with her mother) Not sure why she would have the address sealed he has never done anything to my sister or his children. My niece has had no contact with her dad in years partly because my sister made it difficult for him and partly because he plain didn't try. By any means neither will be parent of the year.
He has always paid the child support and carried the insurance when it had been court ordered. So I have a two part question. First what is a good way to find someone? My niece want to talk to her dad. We have tried the free Internet options, I wrote a letter to his last know address, and even called his last lawyer and he was willing to pass on her info to him but never got any response from him. So either he never got anything or plain doesn't respond. Her dad have a very common name.
Second how do get around Hippa? This past January her dad switched insurance and we just found out by trying to fill her meds (she has asthma) and they where denied. So I had some paperwork here with a person to talk to at his job's HR department. I called her and she was extremely nice and helpful at first. She said that she would call by a certain day and never did so I called her. Her message says to give her two days to return the call. and I would call her about every 3-4 business days. With her never returning a call so I called her supervisor and I got a letter with as little as possible information on her new insurance. I called the insurance and yes she has insurance there but they can't give me a card or her policy number because her dad is the policy holder and Hippa prevents them from giving any information.
Her asthma is not controlled at this time mostly because I can't afford all her meds. So how do I get around this so I can get her the medical care she needs?
I know this has been a long one thanks.
I wanted to add that my sister doesnt take care of these things. She is only around for the good times and pays nothing for her daughter even tho she gets support for my niece. I called the insurance pretented to be my sister (I have had to do this way to meny tims and I know all of her info) they wouldnt give me anything. I understand not giving me any info on her dad but nothing was hard to swallow.
My niece turns 18 soon and going trough the courts at this point is a waste of money.
I meant hippa because of all the privacy laws. I have asked just for her card and they will print one out but it can only go to his address. I have then asked judt for her card numbers again since his is the policy holder they can not release that info to anyone but him. I explained the whole thing that he has no idea where his child is and we don't know where exactly he is either. Just wanted to know if anyone knew of a way to get around this. I called the HR person and have not recieved a call back.
And to the person that told me that I was stepping on my sisters toes, Well if she moved her feet by stepping up to the plate I wouldn't be stepping on them. I have said that to her face. If I waited for her, her daughter would be the one suffering.
Has she tried to contact the insurance company. If she is on the policy, they can give her the information for the insurance. If you have an 800 number for the insurance, have her call them. They can give her the BIN, PCN, ID and Group numbers. That is all she needs for her insurance to work. They will not give her any of her fathers personal information.
The insurance provider can not provide you information on the father but they can provide the child (and/or her guardian) with the necessary cards and information to utilize the insurance coverage. My son's father had him covered for six months before I found out and I had to follow up to get a card on my own (he lived in a different state too). Contact the insurance company tell them that you are the custodian of "your niece's name" who is covered under "her father's name" insurance. Give them as much info as you can and request a copy of the insurance card so she can be seen by her doctor and get her asthma medication.
EDIT-If the person at the insurance company won't send you the card after you word it as being the custodial guardian and no contact with the dad, ask for a supervisor (they are wrong)!
you need to contact her mothers lawyer so he can contact the fathers lawyer to get that in and card released. If she has insurance the company can not deny her the use of it. Call the HR dept again and let them know that you have contacted the child's lawyer. She needs medical help and they are impeeding her health. that should get the ball rolling.
go apply for state help for her-state her case...you can sure bet theyll get to the bottom of it-just to keep her off the state money-
its obvious her dad wants no part of her-so she just needs to let go.your an angel for going thru all this for your neice...i wish you the best of luck-
ps.if she goes onto to college after high school-daddy is still required to pay-also if shes still in high school when she turns 18-daddy still has to pay.but head to the welfare office..theyll handle it all for you.good luck
You probably have to gain legal guardianship of your niece...
Maybe take a trip over to Social Services and explain the dilemma to them and they can either mediate for you or steer you to someone who will know how to get past the Hippa security.
Is there a court order stating that Dad keeps daughter insured? Since he has not informed anyone or sent her a new insurance card he would probably be in breech of that agreement.
Since you know where Dad works, maybe send a registered letter to him explaining that you need the new insurance card and a brief synopsis of her condition and such... include a self addressed stamped envelope for him to return the info.
She's 17, almost an adult... have her write and send the registered letter maybe? If his HR department can tell you who the insurance carrier is maybe you can call them and have them send you the card?
I'd keep bugging his HR dept, they will tire of it and he'll get notified and that will probably make him contact you.
There is nothing in HIPAA (Health Insurance Portability and Accountability Act) that would prevent them from releasing a policy number or ID card to her if they've confirmed that she has coverage and they previously accepted a reasonable request to restrict the use and disclosure of her address and/or to accomodate an alternative address. Quite the contrary, part of HIPAA would have been to facilitate this situation. You need to request a copy of their Notice of Privacy Practices which they are required to give her under federal law. This notice should describe the rights she has to Access her health records, Amend her health records, make a request for a reasonable Accomodation (such as an alternate address, which happens frequently with minor children in divorce situations). There is also a right to request a Restriction on use and disclosure of her health information, if for example, release of that information to her dad could potentially endanger her. I am not sure if your sister requested an accomodation or a restriction. The notice will also provide you with the name of the specific individual who acts as the Plan's Privacy Official. This person is typically, but not always, someone at the employer's office and that is who you should be talking to. If "the Plan" previously agreed to an accomodation or restriction, changing insurance carriers does not terminate the Plan's responsibility to honor that agreement. I suspect they are not calling you back because they are confused with how HIPAA applies or because they know a mistake has been made. There are a few other laws that may impact you. You need to know if a Qualified Medical Child Support Order (QMCSO) is in place and has been accepted by the employer. If yes, this order may name the acceptable "alternate beneficiary" for sending notices, benefit information, checks and that alternate beneficiary might be your sister. You need to know if the employer has sent the National Medical Support Notice to the insurance carrier notifying them of the QMCSO. You also should look into whether the QMCSO ends at age 18, and remember under health care reform, she could be eligible to age 26 if you were able to get the QMCSO amended. You may want to look into this because it is likely much less expensive then if you were to try to buy individual coverage for her and she does have a medical condition that might rate her coverage higher and/or be subject to pre-ex. Lastly, if she is dropped from coverage at age 18 under the QMCSO (if nothing is done to amend it), or once she turns 26 (if the QMCSO is amended), she will be entitled to COBRA coverage for 36 months after that which is self pay, but again typically cheaper/more comprehensive than what is available in the individual market. She would need to take the COBRA coverage for the full 3 years in order to be "HIPAA qualified" (this is another provision of HIPAA that protects the portability of coverage from one plan to another) and have her not refused for coverage by an individual plan as well as have pre-ex waived under the individual plan. One thing that hurts you here is pretending to be your sister to make this stuff happen. It may be worth seeing an attorney. Good luck to you and thanks for stepping in to help your niece, sounds like she needs a responsible adult in her life.
Wow! Kuddo's to you for helping out your niece! What a difficult situation you're in.
This is what I would do and how I would handle it. I would call back the HR dept and ask for the higher up's. Put it on them. Tell them that it is THEIR responsibility to contact her father and tell him what is going on. Tell them that you know they can't tell you anything because of Hippa, but a child's health is at stake here. Basically, they don't want to deal with this, but it would take one simple phone call on their part. Tell them that this child needs for them to do this. You just need to get one person who is willing to make the phone call.
The only other thing I would do at this point is to always ask for generic and go to a place like Walmart that only charges $4.00 per script.
Good luck to you. Your niece will always remember what you're doing for her.
First I wouldn't be so eager to contact dad. Your sister is this child's parent and you should not step on her toes. About the insurance why can't your sister talk to the insurance company? Why doesn't she apply for medicare? Does she have a job? She has options I would talk to her about looking into them.
Sounds like you need a lawyer in the state that issued the divorce and the child custody-support agreement, and you need to get that court to order the father to fix the information situation because he has constructively refused to pay for her insurance because she cannot access care. The court can probably give you the information you seek too, if you have gaurdianship. If you don't, I would get it and collect the child support yourself.
M.
If all else fails maybe they (the insurance company or the HR department) would give the necessary information to the doctor's office and pharmacy.
My husband's ex used to go around and set up accounts in his name with his insurance card that she had for the kids. We ended up changing our policy number to prevent this and then provided the information to the appropriate pharmacy and clinic.
The insurance company should be able to print a card just for your niece, if she is a covered dependent. They must do something, to ensure their customer (your niece), is getting the coverage her father is paying for.
t
