On Dad's HIPAA form. What do I ask doctor for?

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notLola
notLola Member Posts: 10
edited March 2014 in Esophageal Cancer #1
Dad gave me clearance to communicate with Genesis Cancer Center in Hot Springs, Arkansas about his care. He doesn't want me to be a bother to them and will remove me if he gets feedback that I am. I want to know his specific diagnosis with nodes and markers. I want to know full results of his PET scan. I want to know what drugs he has already received, with dose and frequency, and not just the chemo drugs. I want to know expected course of treatment. Since I used to be a biller for an infusion pharmacy, I'd kind of like to know an itemization of his charges and the codes being used and whether or not they are a Medicare Part B participating provider.

How do I get this information in the least obtrusive manner? And are there other things I should request as well? Hate to bug you guys again, but I want to do this right. Suggestions?

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  • notLola
    notLola Member Posts: 10
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    Forgot to mention, I'm in
    Forgot to mention, I'm in Alaska. Oncology office in Arkansas.
  • unclaw2002
    unclaw2002 Member Posts: 599
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    Hi,
    All he needs to do is

    Hi,

    All he needs to do is give blanket permission for you to be provided medical information at the Center he is being treated as --- ask them if they have a form you can get your dad to sign. It should be the same form he signed for your mother. You may also want to suggest if there are any other individuals who will be (on a consistent basis) taking him to appointments, chemo or other therapy to be listed. For example my mother, my brother, uncle niece and myself are all listed as having the ability to obtain medical information about my father. I have been able to speak to the doctor candidly about his prognosis and treatment, I have also been able to make appointments, discuss his care with the nurses, arrange for medical records to be sent, biopsy reports etc. Things that have made his life easier. I also was able to deal with some insurance problems. Additionally, my dad listed me on his insurance and medicare information so that I could deal with them if needed and his primary physician and the cancer team. We coordinated with the medical providers to make sure we got all the releases properly done. I also imagine we may need to update them because they may go stale after a certain period of time. If you are eligible for FMLA you may also ask his doctors to fill out a form for your employer so you can take sick leave (if you have it) to go and help with your dad or to visit him.

    The one thing I have not done is ask for copies of his medical records,lab reports, scan results etc. Lucky for me I have been at some of the appointments even though I don't live near them and my dad keeps a binder with copies of all the test results, progress notes, lab results from blood tests, Pet scan analysis etc. which he will share with me. My dad is a pretty independent individual and this disease has really shaken him --- it is a delicate balancing act to be a supportive daughter verses being the one to direct the treatment. Believe me I am a control freak and if I had my way I would have directed his care in a different manner than he has --- and I have to remind myself that he has been in charge most of his life and I need to respect that even if I think a train wreck is happening (which it is by the way but it isn't my life it is his). This has been a difficult lesson for me to learn this past year since his diagnosis last Christmas.

    I fully understand why you want all that information, but billing codes and everything you are asking for etc may make them go and complain to your father --- and then you would be cut off. Maybe a softer approach would be better and more productive to find out what your dad's condition is and what his treatment is going to be. Perhaps, a conversation with his oncologist where you express your concerns and tell them you have worked in the medical field and while your father may be in denial or only hearing what he wants to hear you would like to have his condition explained without any sugar coating. That you would like to know what treatment the doctors have decided upon and perhaps an outlook as to what you may be looking at and if there are warning signs you should look for as you stay in touch with your dad. If the doctor is not responsive sometimes the nurse will be more talkative, or someone in the oncology/chemo lab, or even the hospital social worker assigned to your parents. Sometimes by asking questions you can get additional services for your parents that might be a big help. For instance I was able to get visiting home health care nurses to come help my mom when they let my dad out of the hospital because she wasn't able to bath him or drive him to physical therapy. They would have never asked for this and didn't think they could get the services.

    I have found over the last year that at first my parents were not as open to talking about his condition or asking for help --- but over time as they have seen that I have been here to help and support them and not tell them what to do (although I have done a bit of butt kicking at times when it was really required) that they have become more open to asking for my help and accepting it.

    Of course everyone is different and family dynamics have alot to do with all of this when you add on top of everything the horrible words you have cancer and the fear that comes with that. I wish you luck and if you have any questions please let me know.

    Best,
    Cindy
  • MOE58
    MOE58 Member Posts: 589 Member
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    WELL SAID
    Just on another note, Cindy said it all basically but since i do medical billing, if he has medicare most all doctors are on part B, and most oncologist will code the office visit or tests correctly now remember Medicare only pays 80% of allowable charges, so for example if he has a charge of $600.00 they allow 200.00 provider writes off 2 00.00 and they pay 125.00 and the patient could have a balance and that is all the provider can bill for so please look at statements closely, and take the explaination of benefits and match up to statement and it should show what the patient is liable for. Now if he has a secondary that will need to be filed with the secondary and most secondaries will pick up the balance, other than non covered services and deductibles. There is always some kind of help for the patient, as in a caring package of assistance through the hospital or doctors office, just a thought. Also when he signs the paper for you to talk to doctors, yes get the details of his progonsis like Cindy said but don't over step your bounds too many questions can be reported to the patient. You will see as the bills come in that insurance usually pays very well. I too was POA over my father so i pretty much knew what i could do and not do. HIPPA IS a big LAW now, and it must be shown on patients file before they will talk to you. Please take Cindy's advice on all things she is pretty knowledgeable and knows her steps.

    If I can help further on insurance questions please do not hesitate to ask me

    Good luck with your dad and know he will beat this beast.

    Lori/MOE
  • notLola
    notLola Member Posts: 10
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    MOE58 said:

    WELL SAID
    Just on another note, Cindy said it all basically but since i do medical billing, if he has medicare most all doctors are on part B, and most oncologist will code the office visit or tests correctly now remember Medicare only pays 80% of allowable charges, so for example if he has a charge of $600.00 they allow 200.00 provider writes off 2 00.00 and they pay 125.00 and the patient could have a balance and that is all the provider can bill for so please look at statements closely, and take the explaination of benefits and match up to statement and it should show what the patient is liable for. Now if he has a secondary that will need to be filed with the secondary and most secondaries will pick up the balance, other than non covered services and deductibles. There is always some kind of help for the patient, as in a caring package of assistance through the hospital or doctors office, just a thought. Also when he signs the paper for you to talk to doctors, yes get the details of his progonsis like Cindy said but don't over step your bounds too many questions can be reported to the patient. You will see as the bills come in that insurance usually pays very well. I too was POA over my father so i pretty much knew what i could do and not do. HIPPA IS a big LAW now, and it must be shown on patients file before they will talk to you. Please take Cindy's advice on all things she is pretty knowledgeable and knows her steps.

    If I can help further on insurance questions please do not hesitate to ask me

    Good luck with your dad and know he will beat this beast.

    Lori/MOE

    Thanks ladies.
    Thanks for the info Cindy and Lori. I should have been more specific. The clearance Dad gave me was putting me on the HIPAA form. Office faxed to me, I faxed to him, he signed and faxed to office. I just wanted to know the best info to request so I know exactly where he stands as far as diagnosis and treatment, and also how best to request it. Fax, nurse, medical records dept, etc? Still a little unsure from your posts what you recommend as method of request. Can you be more specific?

    Lori, I do medical billing too. Started out DME, then to pharmacy (with emphasis on chemo infusion of all things), now behavioral health. So I know how often insurance gets it wrong or something is wrong with the cert of med necessity or provider doesn't write off the over allowable. I'll let it go though. Dad's real sharp and has some family with him who are also very capable. Thanks for the advice though. You're right on target.
  • unclaw2002
    unclaw2002 Member Posts: 599
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    notLola said:

    Thanks ladies.
    Thanks for the info Cindy and Lori. I should have been more specific. The clearance Dad gave me was putting me on the HIPAA form. Office faxed to me, I faxed to him, he signed and faxed to office. I just wanted to know the best info to request so I know exactly where he stands as far as diagnosis and treatment, and also how best to request it. Fax, nurse, medical records dept, etc? Still a little unsure from your posts what you recommend as method of request. Can you be more specific?

    Lori, I do medical billing too. Started out DME, then to pharmacy (with emphasis on chemo infusion of all things), now behavioral health. So I know how often insurance gets it wrong or something is wrong with the cert of med necessity or provider doesn't write off the over allowable. I'll let it go though. Dad's real sharp and has some family with him who are also very capable. Thanks for the advice though. You're right on target.

    I would recomend speaking to
    I would recomend speaking to the nurse coordinator/manager scheduler for the oncologist by phone since you are in Alaska. Tell her who you are, have some information about your dad available, name, birthday, ss# if the hospital uses that, his patient number. Usually they will begin a dialogue with you and not require additional verification - but everyplace is different. I would tell that person that you would like to speak to the doctor about your fathers medical condition, that you live in Alaska and ask that they call you. Try to find out a time/date that they will call so you can be available. I gave them my cell phone number and the doctor called me on that.

    I had met the doctors so they knew who I was --- don't know if that made it easier. As to medicines your dad is being given . . . the hospital can probably give you a form that has all the recent medications. I know my Dad's was two pages long. I helped him with that form because we had to add vitamins and other supplements he was taking. I don't get too involved in the billing issues --- he has Medicare and Tricare for Life so pretty much everything is paid for. The one thing I helped was he was on a Medicare HMO which was a nightmare and we switched back to regular Medicare because the HMO was limiting his treatment, refusing 2nd opinions etc. I know those enrollment periods are coming up so you may want to verify with your dad his medical coverage and make sure he isn't on an HMO. The marketers get seniors to sign up with free health club memberships and promises of excellent care --- but when you need cancer treatment it becomes a nightmare and most cancer centers will accept whatever Medicare and the supplemental insurance will pay.

    By the way my dad will be 79 tomorrow, had controlled Diabetes and High Blood pressure which further has complicated his treatment. He has made it almost a year since being told he had cancer and has surprised the experts with his stamina --- he was Stage III, T3, N2, MO - but now is Stage IV with mets to the liver. He had an opportunity to have surgery, got scared by it and thought the chemo and radiation could beat back and cure the cancer. By the time I had prevailed on him to consider the Minimally Invasive Surgery the cancer had spread to his liver and surgery wasn't an option anymore.

    My dad has been through a real roller coaster but staying active, getting your dad to do exercises especially some weights if possible and making sure he stays hydrated and his wife gets him to the hospital as soon as he can't drink or eat is critical. My dad waited too long on several occassions and really harmed his health and almost cost him his life (didn't want to go into the hospital on a Friday) and he also fought getting the J-tube because he thought that was giving up. He finally got a J-tube and that saved his life -- his current doctor took it out a couple of months ago and now that the tumor is growing again I am trying to get him to get it put back in before he starts a clinical trial. Again, don't know how successful I will be but I try and hope they listen.

    Hopefully this answers this question if you have other questions feel free to send me a private message.

    Best,
    Cindy
  • Callaloo
    Callaloo Member Posts: 135
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    Medical records
    The least obtrusive way to obtain most of what you want is to request directly from the records department (assuming your dad has signed the necessary ROIs), and so long as you know how to read the reports and regimen and lab summaries, you won't be bothering anyone. Same goes for billing records. Just call the "back office".

    I can read my CT and PET scan reports online, and so can anyone else to whom I provide my password. Maybe your dad's cancer center has similar online services. So if you're concerned about pestering the care providers, talk to someone in records first to see what they are able to provide you access with. Biopsy and scan analyses will all discuss diagnosis and extent of node involvement and other metastesis. None of the records will mention prognosis, if that's what you're looking for, and my own doctors are reluctant to discuss this in any detail with me, other than to acknowledge that the general prognosis for stage IV is poor.

    The National Comprehensive Cancer Network (NCCN.org) publishes practice guidelines which outline currently accepted approaches to treatment which you may find useful.
    Good luck.