Unum as a “Covered Entity” under HIPAA

Comments were closed by this blog before I was able to respond, so here’s my last post:

http://lindanee.wordpress.com/2014/12/05/daily-buzz-8/

There are many different kinds of car insurance — coverage for liability, flood, collision — but they all involve the use of a car.

There are different kinds of health care providers too, but they all provide a service that involves your health.

So, is a disability insurance company considered a “Covered Entity” under HIPAA? Here’s part of hhs.gov’s definition:

2. A Health Plan

This includes:

Health insurance companies
HMOs
Company health plans
Government programs that pay for health care, such as Medicare, Medicaid, and the military and veterans health care programs

3. A Health Care Clearinghouse

This includes entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa.

Unum as a health insurance company: It can certainly be argued that disability insurance is a type of health care insurance. Disability insurance is for when your health declines to the point of disability. Do healthy people use disability insurance?

Unum as a company health plan: Unum’s policies are offered as additions to company health plans, including coverage for worker’s comp and short/long term disability.

Unum as a Health Care Clearinghouse: Doesn’t Unum fit this description? Maybe Unum doesn’t communicate with its insureds by electronic means, but I’m sure they use email and other digital technology with all their subsidiaries, vendors, etc. And doesn’t ERISA (which Unum has to follow) include HIPAA rules?

Unum as a government program that pays for health care: Can we consider ERISA as a type of government program? And I know that Unum provides disability insurance to government contractors, but I don’t now if it provides benefits directly to federal and other government employees.

“All matters relating to disability insurance are matters of contract and the contract always rules (including the provisions of discretionary authority).”

Contracts are just words, and words tend to have more than one meaning. It may not be easy to attack the contract itself, but as you say, the contract always rules. But the contract is not God, and neither is it the federal government.

I don’t expect my arguments to convince anyone at Unum — at this point, they are only made to save and protect them for the record.

“No regular medical treatment, no benefit.”

I’m still waiting for someone to define “regular medical treatment.” Especially for a 25-year intractable pain condition. As an expert on pain management, I can tell you that there is no such thing as “regular medical treatment” for a chronic pain patient. Since the medical industry gave up on me as a chronic pain patient, what will I be seeking treatment for?

If you don't comment, I'll just assume you agree with me

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