Private Insurance Data Requirements in Massachusetts
Massachusetts law requires that all consumers have access to their personal or medical information from an insurance company. An individual who seeks his or her recorded personal information from the insurance company must submit a written request to the insurance company.1 There are also regulations in place that prevent health insurance companies from disclosing consumers’ privileged or personal information without the individual’s written authorization.2 As part of Massachusetts health care overhaul, employers and employees are required to fill out a health insurance responsibility form, on which insurance coverage is reported. This information cannot be made public, however, it may be shared with the Department of Revenue, the Commonwealth Health Insurance Connector, and the Health Care Access Bureau within the Department of Insurance, for enforcement purposes.3
All insurers must inform their consumers of how to file grievances,4 establish a policy for consumers to file grievances5 and as well as system to maintain records of each grievance and its outcome.6 Any confidential medical information obtained as part of the grievance process cannot be released unless the individual authorizes its release in writing.7 Additionally, health insurers are required to provide its consumers with a list of providers, information about their rights as consumers, and payment, cost and utilization information, upon request.8
Massachusetts also requires private health plans to report all individuals who are also recipients of medical assistance to the Division of Insurance. The law prohibits the health plan from being held liable for the release of this information.9 Further reporting required by the state includes uniform reporting of information from private payers of health care to allow the Division of Health Care Finance and Policy to analyze changes in cost and utilization, reporting of claims data in order to develop and maintain a database of health care claims, and reporting of summary information about plans and costs, and provider payments.10