Reducing HIPAA Risk: The Importance of Outsourcing Benefit and Healthcare-Related Questions

By: Derek Fitteron, President of Emry Health

Imagine a business owner, whether at the helm of a promising startup or steering a well-established corporation, grappling with the day-to-day complexities of operations. Add to this the intricate challenge of managing employee benefits—a task that magnifies in difficulty when it involves sensitive healthcare inquiries. The stakes are particularly high in these situations, where mishandling such personal health information (PHI) risks violating the Health Insurance Portability and Accountability Act (HIPAA) and jeopardizes both employee trust and the company’s legal standing.

Current Challenges and Risks

While HIPAA was designed to safeguard PHI, companies across the U.S. from small businesses to large enterprises often find themselves struggling to maintain compliance. Large organizations, despite having more resources, face their own unique challenges due to their scale and the sheer volume of inquiries, which can complicate oversight and increase the risk of breaches. 

Small to medium-sized businesses often lack a specialized benefits manager, forcing employees to direct their healthcare and benefits questions to whoever seems most likely to have the answers, which often ends up being personnel in finance or even company executives. Executives and other non-specialized staff often lack the necessary training to handle PHI, resulting in unintentional privacy violations that can escalate quickly within the organizational hierarchy. For instance, a seemingly benign act of forwarding an employee’s email containing PHI to another colleague for better resolution is a breach of privacy if proper consents are not in place. Moreover, without the proper authorization forms, even contacting an insurance company on behalf of an employee can result in compliance violations.

The Role of HR and Benefits Leaders

Even HR and benefits leaders, who might be expected to manage these sensitive employee inquiries, face significant challenges that make them less than ideal handlers of PHI. Typically burdened with a wide array of responsibilities, HR professionals may lack the time, specific training and resources to ensure every interaction complies with HIPAA regulations. This overextension often leads to mistakes, such as mishandling PHI or failing to properly secure consent forms, which significantly raises the risk of compliance breaches. In many cases, HR staff are not fully trained in the complex legalities of HIPAA, making it risky for them to manage health information without inadvertently committing violations.

Potential Consequences

HIPAA violations are not merely regulatory faux pas but can lead to serious repercussions including litigation risks such as claims of wrongful termination or discrimination. For example, if an employee’s health information is mishandled, and they are later terminated for unrelated reasons, they might claim that their health data influenced the decision, placing the company at significant legal risk.

The Role of Benefit Navigators

External benefit navigators take on the responsibility of managing all benefit-and-health-related inquiries, ensuring that HIPAA consents are correctly filled out early on, and any PHI data is securely encrypted. This not only safeguards the employee’s sensitive information but also significantly reduces the company’s exposure to compliance risks.

Benefit navigators specialize in these tasks, equipped with the tools and expertise to handle sensitive information securely and efficiently. They serve as a secure intermediary between employees, the company and insurance providers, ensuring that all communications adhere to HIPAA standards.

5 Reasons Companies Should Outsource These Functions

  1. Expertise
    Benefit navigators are experts in the fields of healthcare and legal compliance, ensuring that all interactions are handled correctly.
  2. Reduction in Internal Burden
    Outsourcing these tasks frees up company resources, allowing internal staff to focus on their core responsibilities rather than managing complex benefit inquiries.
  3. Decreased Legal Risk
    With professional navigators, companies minimize the risk of HIPAA violations and the associated legal and financial consequences.
  4. Enhanced Employee Trust and Satisfaction
    Employees feel more secure knowing their personal health information is handled by experts, which can improve overall job satisfaction and trust in the company.
  5. Security
    Professional benefit navigators use encrypted databases and secure messaging portals to maintain the confidentiality and integrity of PHI.

For companies, moving away from handling benefit and healthcare-related questions internally and adopting an external benefit navigation platform is not just a strategic move—it is a necessity in today’s regulatory environment. It ensures compliance, reduces legal risks, and allows companies to focus on their primary business goals while providing employees with the assurance that their health information is managed with the utmost care and professionalism.


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