11/10/25 Common Concerns in Healthcare

What is the biggest law that healthcare providers need to follow?

The Health Insurance Portability and Accountability Act (HIPAA) is the primary law that healthcare providers must follow to ensure patient privacy and security of health information

What is Title I?

Protects health insurance coverage for workers and their families who change or lose their jobs. It limits new plans’ ability to deny coverage due to a pre-existing condition

What is a pre-existing condition?

A health issue that was present before obtaining new health insurance coverage, which can lead to coverage denial or waiting periods.

ie: pregnancy, diabetes, or asthma.

What is Title II?

Prevents Health care Fraud and Abuse; Medical Liability Reform; Administrative Simplification that requires the establishment of national standards for electronic health care transactions and national identifiers for providers, employers, and health insurance plans

**This is what most people think about when they think about HIPAA

What is Title III?

Guidelines for pre-tax medical spending accounts. It provides changes to health insurance law and deductions for medical insurance.the

FSA: Flexible Spending Account

HSA: Health Savings Account

What is a flexible spending account?

An arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. Allowed expenses include insurance copayments and deductibles, qualified prescription drugs, insulin, and medical devices.

Leftover:

2.5 months to spend the leftover money

carry up to $640 to spend the next plan year

What is a health savings account?

An investment account available only to members who are enrolled in a High Deductible Health Plan (HDHP). Your HDHP credits a portion of your premium to the HSA. You can also make pre-tax contributions.

These funds can be used to pay for your plan's deductible and/or qualified medical expenses that do not go towards your deductible

Leftover:

earn interest

Roll over any remaining balance from year to year

What is Title IV?

Guidelines for group health plans. It provides modifications for health coverage

A lot of the nitty-gritty details about insurance, like:

• paperwork timelines for claims

• changing coverage due to qualifying life events (marriage, divorce, life, death, loss of job, house fire, adoption)

What is Title V?

Governs company-owned life insurance policies. Make provisions for treating people without United States Citizenship, and repeal the financial institution rule to interest allocation rules.

Mostly has to do with self-insured groups

What is mandatory reporting?

In the U.S. , mandatory reporting laws establish a legally enforceable duty for those who have contact with vulnerable populations to report to state and local authorities when mistreatment or abuse of those populations is suspected or confirmed. Laws vary by state and population but in general cover:

• children

• disabled persons

• and elderly

Children: mandatory reporter?

1 in 8 kids are abused in some way before they turn 18.

Homicide is one of the top five causes of death for children in every age group

Elderly: mandatory reporting?

While these cases are less common than child abuse they are still very common and often times have more to do with money or medical/care giving neglect.

Who are mandatory reporters?

teachers, medical professionals, first responders

What are three ethical issues?

Treatment plans, availability, communication

What are treatment plans as ethical issues?

What if the patient doesn’t agree with a course of treatment?

• Reasons could include religious beliefs, past experiences, or even education

What is availability as ethical issues?

How does an ED determine who gets seen first? What happens if a clinic is running low on supplies?

What is communication as an ethical issue?

What happens when patients and physicians speak different languages?

How is medical information shared among providers? Who owns your medical records?