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HIPAA requirement for processing insurance claims Texas

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by Vikas_1, Oct 17, 2016.

  1. Vikas_1

    Vikas_1 Law Topic Starter New Member

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    Jurisdiction:
    Texas
    My mother visited Texas from south East Asia to spend few weeks with me here in TX. However, she passed way due to a sudden illness. The travel insurance company, which is based in US, is requesting Power of Attorney or Executor of Estate from the deceased person’s husband or her nearest kin in US.

    Already hospitals have submitted claims to the insurance company; however they are not discussing the claim status with the family members. Insurance personnel stated that only with the executor of estate they will discuss the claim status. They cited that this is HIPAA requirement & they will not discuss any of the insurance claim related questions with us.

    Funeral home expenses was part of the insurance coverage, however when the bill was submitted, they rejected the claim & did not provide the reason for rejection. They cited it is the requirement within HIPAA, which prevents them from providing us the reason for rejection.

    Q1: Is this a valid HIPAA requirement, that insurance company will not discuss claim details with the nearest kin, either her daughter or husband.

    Q2: Is there any way I, deceased person’s daughter & only nearest kin in US, can obtain executor of estate from a probate court in US (TX). Also, deceased person has no property in US & her country residency is India

    Q3: Since this is mainly for health insurance purpose, is there any other legal document which court can issue, such that I use this document to discuss claim status

    Eagerly awaiting your response.

    Thanks,
    Vikas
     
  2. adjusterjack

    adjusterjack Super Moderator

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    Yes. It's a valid requirement. It doesn't even have to do entirely with HIPAA.

    No one will talk to anybody about a decedent's business unless that person is executor or personal representative of the estate and has the court papers to prove it.

    That's a given throughout the US so you are going to have to resign yourself to opening probate and getting your papers before anybody will talk to you.

    Tough question. You can try filing the small estate affidavit at your local probate court.

    Here's the packet from Harris County. You can probably find similar forms and instructions in your local court:

    http://www.cclerk.hctx.net/forms/i0222.pdf

    I don't know what to tell you about question 2. You'll just have to wing it and hope it goes through so you can get your papers.

    Nope. Sorry.

    I went through the same thing in NY when my mother died and later when my brother died.

    When an entity says "We do nothing without your court papers" you get the court papers. There's no getting around it.

    Talk to a Texas probate attorney if you want professional help.
     
  3. Vikas_1

    Vikas_1 Law Topic Starter New Member

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    Adjusterjack,
    Thank you very much for your reply. I reached out to some attorneys in TX & awaiting their response.

    Thanks & best regards,
    Vikas
     

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