I assume a doctor is a private business. I have good insurance, I have medicare and then I pay premiums for a secondary insurance.I do not believe that medicare requires one to have a designated Primary Care doctor. I know that my private insurance does not.
The office of my doctor want me to list her as my primary care doctor, claiming that there is a fee if I do not. She was busy so we did not go into that fee issue being real or not. Is a doctor legally allowed to charge one a fee if he or she refuses to list that dr as the primary care doctor?? Can the doctor say goodby to you if you don't? Does being listed as a primary care automatically give that doctor legal rights to your medical records? I am interested in maintaining my privacy as much as I can.
HIPAA privacy law under both federal and state "mirror" statutes guarantees a patient the right to secure information. When you filled out the paperwork, you likely completed a HIPAA authorization form that allowed the physician access to your records. This is reasonable since physicians should have as much information about your medical history as possible to properly administer treatment. Physicians may legally share your protected health information (PHI) with third parties such as insurance companies or laboratory test facilities if it relates to treatment, billing or payment, or health care operations. They may only share that which is the "minimum necessary" to accomplish the necessary purpose. Moreover, the HIPAA privacy rule, technology rule and security rule requires the physician to have password protected computers, limited access to records by staff, and numerous other measures to protect an unauthorized disclosure or "breach". Beyond that, a physician must have a separate signed authorization from you, the patient, to disclose any of your PHI to any other party. Primary care physicians are required by insurance contractors for reimbursement purposes. I know of no statute that would bar a service fee for lack of such a designation, and I anticipate the physician is offsetting a lower reimbursement for treating a patient who the insurance company considers "out of network". You also have the right to restrict disclosure of your information or prohibit such disclosure altogether without your express authorization. Most physicians have forms for this, but if not, ask. If you have a particular medical condition of a sensitive nature that you are concerned about, you may wish to consider this option. The government takes HIPAA breaches very seriously and stiff fines and penalties are assessed for breaches. These can range from $1,000-$50,000 for a single breach up to $1.5M for repeated offenses. Bear in mind that because most states now have similar statutes, such a breach would also be subject to state fines and penalties. You have the right to a copy of your medical record. It must be produced within 30 days under federal law. The physician can charge a reasonable fee for copy and film reproduction charges. You can request an electronic version of your record. Some states, like Texas have shortened such requests to 15 day response time by the physician. Patient rights under the Health Information Portability and Protection Act are extensive. Absent carelessness or a deliberate act on the part of a provider, your information should remain secure.
I agree with the response from my learned friend from Texas. I add that the Affordable Care Act adds a new Medicare benefit that will make preventive services more accessible for seniors and the physician's request to make you designated the physician as a primary care physician for you is most likely why the request was made. Beginning in 2011, Medicare invested approximately $3.6 billion to cover a free annual wellness visit during which each beneficiary will receive a personalized prevention plan. The checkup should include a personalized health risk assessment, a review of personal and family medical history, and screening for cognitive impairment; in addition, a list is required to be compiled of all doctors providing care to the patient. The additional fee requested for non-designation as a PCP ("Primary Care Physician") may be prohibited if the fee plus charges exceed 115% of the allowable Medicare charge for the encounter of establishing a new patient. Lastly, under Florida medical practices regulations, the cost for a patient to obtain medical records copies are $1 per page for the first 25 pages and $0.25 per page thereafter and this does not include reproduction charges for documents such as an x-ray film, etc. of which actual reproduction costs can be charged back to the patient. Lastly, I add that it is a good idea to designate a PCP as even suggested by AARP if given an emergency you seek treatment at an emergency room or are eventually admitted to hospital where the PCP might not have privileges as whilst there is always a concern about improper disclosure or access to protective health information, your medical history and list of current medications being made available by your PCP to others involved in your health care actually can protect you from very bad outcomes if you are unable to communicate and assists in the quality of your continuing care.
