Health insurance in the USA | Health Insurance Company Medical Records


The Health insurance in the USA is given free to their people as it is provided by the government. In the USA they provide low-income citizens with approved medical aid within a month or two (depending on the worth of their vehicles and assets). a person with little savings, having an income of $30,000 in the family of four, and don’t have any large assets transferred recently. These requirements are main to get medical aid in New York. A person diagnosed with a severe illness would most probably get approval within two weeks.


Health Insurance System

To know the complexities of the health record system, it is obliged to know about that what the health insurance information has been, at present, and compelled to become. The communication tool either paper-based or electronic supports clinical decision-making coordination of services effectiveness of care and quality. The business record must document in the normal way of its activities. Only authentic documentation is accepting.

Probability and Accountability act of 1996 (HIPPA)

This is a federal law that needs the creation of national standards to save tactful patient health information from being leaked. Without the patient’s agreement or knowledge.HIPAA privacy rule was implemented by the US Department of Health and human services (HHS) to protect HIPAA privacy rule.

HIPAA privacy rule 1996

The HIPAA privacy rule contains how individual privacy and health information is used. A major goal of this act is to promote a high quality of health information is properly protected, this privacy rule also balances the important use of information who seek care and healing.

Covered entities

Following individuals and organization are subject to privacy rule:

Health care providers: People who make any transaction in terms of claims, eligibility inquiries, and other transactions.

Access to medical record

Medical records were previously were handwritten and were used for research, financial purposes, clinical and administrative. The information was accessible to one person at a time. The paper-based record resulted in delays for record completion that lasted for months and more. Paper-based medical records had ended up in lack of security. (Harman, 2012)

According to the insurance probability and accountability act (HIPAA), the law keeps medical records privately, shared only amongst a person’s doctor themselves and maybe caretaker. (Torrey, 2020). there are scads of people and organizations who have excess records legally for many reasons either by request or purchase. In some cases, we provide information without any realization that we have done so and sometimes records are illegally approached.

Types of Medical record:

There are two types of the medical record:

Individual Identification record: which consist of personal information such as person’s name, doctor insures, diagnoses, treatment, etc.

Aggregate medical records:  This type also explains itself that thousands of records are composed into several lists to make one aggregate list. These records are used for various reasons. These organizations have the right to share or sell it as long as it is de-identified.

Virtuous of Access:

HIPAA allows only some individual to access your medical record under HIPAA these are classified as covered entities, covered entities comprised of the allied medical professional, doctors, payers (Like Medicare), facilities (Like nursing home and labs) these help to maintain electronic health records and the government

As covered entities, some rules must be strictly followed and it demands written permission from the person having the record, recommendation given under HIPAA are as follows:-

Caregiver or loved one can have copies of your medical record too but written permission should be provided

It is legal to have copies of your medical records

As per HIPAA, your payers have virtuous to get copies and use your medical record. Any institution entity like medical aid, workers compensation, insurance companies, social security disability, Medicare, department of veterans affairs are paying for your health care needs can review your records.

State and the federal government: have virtuous to your medical record. Medical payment requires access to other agencies, such as child protective services and law enforcement. The occupational safety and health administration (OSHA) GET INTRICATE if you face an accident at the workplace.

Health care providers have virtuous to see and share your records to whom you have grant permission. E.g., your doctor mentions you to a specialist. So you may ask to sign a form that allows he/her to share your records with that specialist.

Medical Information Bureau

Known as the MIB group, they have an individual record on you and it doesn’t concern HIPAA laws. The MIB group was found in the past 125 years ago and is a nonprofit entity, that provides information to life insurance to evaluate eligibility for the report.

Employers working under HIPAA cannot access medical records, even if they pay for your insurance or medical care, HIPAA forbids it and can result in distinction.


How Insurance Companies Have A Record?

An insurance provider can only see medical records if permission is provided by us, whereas in certain cased public bodies e.g. police, social services, etc. can access your records without your consent

Below are some cases from where records are extract:

  1. Previously same claim reported in the same insurance companies
  2. The previous claim admitted with another insurance company with familiar information presently
  3. Application is give to the insurance company with relevant medical documents
  4. An insurance company has been providing permission by yourself to collect medical reports on your behalf as a part of the requirement of an insurance company for claim
  5. Insurance companies have also joined hands with data brokers to get all the personal information of thousands of Americans e.g. grace, education level, TV habits, clothing, and online shopping behavior, and much more to predict how much it would cost them to provide your health insurance. Every minute details are important for Organization to predict the health cost for the customer

At IBM Watson health booth, Kerin Ruane, a senior consulting scientist told that the company surveyed 80000 Americans a year to access the lifestyle, attitudes, and daily routine which could relate to health care responses of hundreds of people and analyze together to identify socio-economic factors of an area.

Illegal Disclosure of Record

There are many means of accessing records some are legal and some are illegal. In this era where technology has overcome human ability the sometimes it has some pros and cons. Hackers have easily gained access to many private records such as credit card information health records and other sources of information. Access to medical information is more harmful as it may create a fake identity. Which happens frequently (Torrey, 2020)

Medical records are of much importance specially in the case of plastic surgeries and other types of surgeries of well-known people or celebrities

Medical information is also mostly accidentally leaked and unintentionally made public e.g. data In your hard drive which does not work but it does not mean it cannot retrieve.

How To Protect Your Data?

Many people are concern about their medical data by not giving data as they have the fear that their data will be shared by the government, retailers, and Employers. Patients also withheld their information during visits which put patient’s health at risk.

HIPAA gives rights to a patient if they do not want to share the information. Until he/she allows to share. You can even file a complaint if your information is misuse or improperly file you can even ask the provider to correct it if incorrect information is provides.

How To Aggregate Record Is Use?

Aggregate records once compile can use for a variety of reasons and organizations have the right to share or sell the information as long as it is de-identify.

Research – Aggregate data helps in the research of patients and upcoming professionals.

Selling data – Selling the aggregate data may be beneficial for many companies such as hospitals having data of spinal surgeries, they may sell to companies making wheelchairs. And a lab or pharmacy may sell its data to pharmaceutical companies for making effective leads to a large source of revenue for any organization.

Pros and Cons of Health Insurance:


  1. It decreases health care cause as government controls it through negotiation and regulation.
  2. It lowers administration cause as doctors only deal with government agencies.
  3. Breach of information forces hospitals and doctors provide
  4. Increases transparency in the transaction
  5. Health insurance helps to know the real cost of health care
  6. Reduces medicine cost of any illness


  1. Selling health insurance to the US constituency is difficult.
  2. Selling it to the US policymaker is also difficult.
  3. The difficulty faced in transition.
  4. Tax needs to change, giving health coverage would be a useful way to give an advantage.

This year ProPublica and NPR Investigation on various techniques that insurance companies are multiplying their profits. Understanding these strategies is important because patients are paying through tax cash payments and insurance premiums and lower bills are not the insurer’s top priority.


EMR stands for an electronic medical record which is in digital form same as paperwork charts fig, or any medical data stored in paper form. An EMR typically contains general information such as treatment medical history of patience

Electronic medical record (EMR) which will help health care workers to have coded and processed by the ministry of health and family welfare. All medical data of customers will code which would difficult of getting information to insurance companies. (Saraswathy, 2013). Avantika Bhandar, director of marketing  said that this coding system will be quicker access to patience data and will help underwriting and claim process and make strong bond in customer service and satisfaction but this process would take time, and have to admit that things won’t get better in just one night require an investment of time and resources

Benefits of EMR

EMR is design to help patience and health care providers it gives precise information of each patient and track its data to many health care providers and can take follow-ups of their checkups, screening and monitor how each patient blood pressure readings and due vaccination. EMR makes it easy for health care workers as they do not have to carry different charts but only an electronic chart that can be accessed by all health care workers.

Financial Benefit

Due to the implementation of EMR, you would notice there would be a decrease in overall expenditure. according to a study published in the American journal of medicine providers saved on drug expenditure, improved efficiency in radiologic diagnostics upgraded the recording and reporting of billing services and decreased billing also improves the quality and safety of patient care. Due to EMR, you can prescribe other medicine to patience as your record is accessible with health care workers due to which you could get service online and save time. (medicine, 2020)

EMR software system will also provide links, articles, images, and videos for a better understanding of their health issue and health care which can help them to improve their lifestyle. Through this system, they can also receive their health care copies upon request.

Public Health And Medical Care System

Although the US is renewing for its leadership in biomedical research, its hospitals, and technology there is a disadvantage in the US of deficiency in health services (Woolf SH, 2013). Reason for poor health services is the higher mortality rate from diseases and even from transportation-related injuries.

In 2010 50 million people approx. 16 percent of the US population were uninsured (DeNavas-Walt C, 2010). The United States was not offering universal health insurance coverage. The United States has relatively weak Pillars for primary care and a shortage of family physicians (Leawood, 2009).

Cost-sharing is common in the United States and expensive which makes health services, and medication unaffordable. But many health care providers are focusing on the eradication of this issue for many years.

Access to Public Health And Medical Care

Access to Public Health Services

Public health services are complex and financed by the federal state. Local and private sources vary across communities. And fluctuate over time depending on other factors like budget and decision of state and federal government. It is estimate that the United States spend 3 to 9 percent on Public health (Mays GP, 2011)

Access to Medical Care

Access to medical records in the United States is limit for people in the United States. Americans have a lack of confidence in their health care system than other countries. As compare to countries it is reports that only 70 percent of the U.S seem too confident. On health care system provided to them.

Health Insurance Coverage

Only three OECD countries-Chile Mexico and turkey provide less health insurance coverage than the United States (OECD, 2011). This is because Americans face less affordability and financial barriers in accessing health care insurance. Even among insured adults age under 65,25 percent reported serious difficulties in paying medical bills. And 40 percent reported cost issue. (Schoen C, 2011).

How Health Insurance Companies Use The Information Gathered?

Your life insurance quote is higher if you drink alcohol, smoke, overweight, high blood pressure, or any disease. Health Insurance Companies gathers details of your daily routine. With the more information they gather more accurately they can price the premium. It also depends on your hobby. If you have any dangerous hobbies which may lead to an accident or life insecure. Then it would cost you higher as well. Your life protects them and they need to make sure the road is paved. So you are cover for anything that may happen to you in the near future.

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