Question about Patient Consent and Potential HIPPA Violation With Insurance

Prescription Insurance Consent/Privacy

Prescription Insurance Consent/Privacy

Do you have to give consent for the pharmacy to provide your information, or a prescription, to your insurance company?

If the pharmacy faxes the prescription to the insurance company, which is required by the insurance company for certain prescriptions for a pre-authorization, is that a HIPPA violation?

Answer:

My questions for you are these:

Did you give the pharmacy your prescription insurance information? If not, then how did they get your insurance info?

Did you give the pharmacy your prescription? Did you request the pharmacy fill your prescription and run it under your insurance?

My point is that if your expectation and desire was to have the pharmacy fill your prescription and run it under your insurance, and you gave both to the pharmacy, why would it be a HIPPA violation for them to do what you are requesting and expecting them to do?

Prior Authorizations involve the pharmacy contacting the prescriber and requesting the MD or ARNP or nurse practitioner to make contact with the insurance company. The prescriber will provide the insurance company with required clinical information so that the insurance can make an informed decision to pay or deny the claim. During the course of normally filling a persons prescriptions, the claim is transmitted electronically from the pharmacy to the insurance. This is done through the internet, using the pharmacy's software program. Nearly all parts of a prescription (Patient name, drug, quantity, directions, doctor name and NPI or DEA number, etc) are sent to the insurance company anyway. Sending a copy of the prescription to the insurance for a prior authorization seems to me to be a non-issue in terms of HIPPA. The insurance already has all of the info.

As for the issue of consent, most pharmacies wouldn't do anything that hasn't been requested of them to do. You've given the prescription and your insurance to them. You've not told them to not run it through your insurance. The expectation here is that they will.

If you'd rather not use a particular pharmacy, you always have the option of getting your unfilled paper prescription back. However, if the prescription has been filled once or more, and picked up, the RX must be retained by the pharmacy for record-keeping purposes. A pharmacy employee will also be able to reverse the filling of the prescription thru your insurance.

Thank you for the question.

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to HIPPA Question Invitation.

Back to Home

[?]Subscribe To This Site
  • XML RSS
  • follow us in feedly
  • Add to My Yahoo!


Didn't find what you were looking for? Use the box below to search this entire site.

Custom Search



Recent Articles

  1. What are some good strategies to preventing medication errors in the pharmacy?

    Apr 22, 18 11:04 PM

    It seems like some of the errors that have been recently made by our pharmacy techs are actually really preventable. Are there any good strategies that

    Read More

  2. Prior Authorization Rejection

    Apr 10, 18 11:13 PM

    This page covers what a Prior Authorization is and why it happens.

    Read More

  3. My 10 yr olds prescription -- Is The Following Situation a HIPPA Violation?

    Apr 10, 18 10:00 PM

    I know someone who is a pharmacy tech. My 10yr.olds medication was called into the pharmacy she works at. Her daughter and my daughters have an on-off

    Read More

  4. My Pharmacy told my mom that I didn't pick up my meds. Is this a Hippa Violation?

    Apr 10, 18 09:26 PM

    My pharmacy told my mom I didn't pick up my meds. Yes, I do have same last name but I have a different address; for all they know, that wasn't my mom.

    Read More

  5. Vitamin Resources

    Apr 08, 18 02:43 PM

    Vitamin Resources - Information about Vitamin A, The B Vitamins, Vitamin C, and Vitamin D.

    Read More

  6. Two HIPPA Questions: Including, Can Pharmacy Techs counsel patients?

    Mar 27, 18 10:20 PM

    under the hippa law can a pharmacist and a pharmacy tech speak about a clients medical record amongs each other and cam pharmacy techs counsel the patient

    Read More

  7. Should pharmacy errors be reported anywhere?

    Mar 27, 18 10:11 PM

    Our pharmacy manager wants us to report any pharmacy error that happens. Why is it important to report errors? Where should we report the errors to?

    Read More

  8. Former employee working for competitor; Enticing former customers to new pharmacy

    Mar 27, 18 09:32 PM

    We had a pharmacy tech resign, then go to work at a grocery/pharmacy - the tech has used PHI to target our patients and entice them to transfer their prescriptions.

    Read More

  9. Wondering how many Percocet I should have left in my bottle?

    Mar 27, 18 08:57 PM

    I got my 120 Percocet Feb 18 how many should be in my bottle March 16 i take 4 a day

    Read More

  10. If my pharmacist states the name of my medication very loudly at pickup, is that a Hippa violation?

    Mar 27, 18 08:32 PM

    Is it a HIPAA violation if a pharmacist says what you are taking very loud so others can hear what you are taking?

    Read More

  11. Is Publicly mentioning the name of the drug the patient is on a HIPPA violation?

    Mar 20, 18 08:53 PM

    If the name of the drug is mentioned in order to further assist the patient with getting them the medication, is this a violation of hipaa?

    Read More

  12. Osmolarity/Hospital Potassium Infusion problem (3 Part Question)

    Mar 20, 18 08:43 PM

    At 3:00 P.M., a pharmacist received an order to add 30 mEq/L of potassium chloride to the already running intravenous fluid for a patient. After checking

    Read More

  13. SILICONE RINGS IN A CLEAN ROOM

    Mar 20, 18 08:39 PM

    The USP797 rules state that no jewelry can be worn in the I.V. clean room setting because it wouldn't be sterile. I was wondering if silicone rings would

    Read More

  14. What is a "Root Cause Analysis"? And how does a pharmacy create "healthy safety culture"?

    Mar 20, 18 08:38 PM

    Recently there was a wrong-drug mistake at the pharmacy I'm employed at as a technician. One of my tech friends (who works at a different pharmacy) asked

    Read More

  15. Liquid Morphine: How many days will my meds last?

    Mar 20, 18 08:32 PM

    I am a post surgical patient I am on liquid morphine 22ml bottle. I’m allowed to take 2ml every 3 hours how many days should by bottle last?

    Read More