(Part III continues Part I and Part II of this series on privacy of health information in the domestic relations context, which may be found here and here. Capitalized words not defined in this Part III shall have the meanings assigned in Part I or Part II.)

6. The situation can be further complicated by the fact that the Affordable Care Act requires Insurers that offer dependent coverage to make the coverage available until the adult child reaches the age of 26 to avoid loss of health insurance for students after they graduate from college. Most Insurers permit adult children of 18 or over (e.g., those emancipated under state law) to block access to claims information by their parents, regardless of the fact the parent is paying for the coverage. Such an adult child is typically not a party to divorce settlements or decrees. In some states even minor children below the age of 18 may be permitted to block access to claims information by their parents.

7. HIPAA permits an individual to require a Provider to agree to the request of such individual to restrict disclosure of protected health information (“PHI, as defined in HIPAA) about such individual to an Insurer if:

a. The disclosure is for the purpose of carrying out payment or health care operations (but not treatment) and is not otherwise required by law; and

b. The PHI pertains solely to a health care item or service for which the individual, or person other than the Insurer on behalf of the individual, has paid the Provider in full.

Adopting this payment approach may allow an individual to prevent his/her spouse from learning about specific events of diagnosis and treatment relating to such individual or his/her custodial children that would otherwise be available by access to claims information through an Insurer.

8. HIPAA provides that individuals have the right to request restrictions on how a Provider will use and disclose PHI about them for treatment, payment, and health care operations. A Provider is not required to agree to an individual’s request for a restriction, but is bound by any restrictions to which it agrees. This type of self-help initiative may enhance efforts to block access by a spouse or former spouse, either alone or in aid of other measures.

9. HIPAA also provides that individuals may request receiving confidential communications from a Provider, either at alternative locations or by alternative means. For example, an individual may request that her Provider call her at her office, rather than her home. A Provider must accommodate an individual’s reasonable request for such confidential communications. An Insurer must accommodate an individual’s reasonable request for confidential communications, if the individual clearly states that not doing so could endanger him or her. Again, as in item 8, this type of self-help initiative may enhance efforts to block access by a spouse or former spouse, either alone or in aid of other measures.

10. A wide range of changes in circumstances, such as a change in employment and/or Insurer, obtaining services from a new Provider, relocation to a different state, changes in state law, reaching of majority age by children and/or life event changes that relate to provisions in a divorce or separation agreement or decree warrants revisiting these tips from time to time. HIPAA rights and responsibilities must be re-evaluated regularly in the context of the facts and circumstances involved at any given time.

Conclusion

The foregoing discussion refers to only a few of the many permutations of issues that may arise regarding IHI in the domestic relations context. It is intended to indicate the wide diversity of challenges and opportunities that spouses and domestic partners may encounter regarding access and blocking access to IHI. Individuals who need advice regarding legal aspects of their domestic relationships and/or disputes should seek counsel of professionals who have familiarity with the ramifications, complexities and continuous changes involving HIPAA, state privacy laws and IHI.