The 164.522 a exception under which a healthcare provider must agree to a request for restrictions is as follows: A provider must agree to the request of an individual to restrict disclosure of protected health information about the individual to a health plan, if:
- The disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law; and
- The protected health information pertains solely to a healthcare item or service for which the individual, or person other than the health plan on behalf of the individual, has paid the covered entity in full.
The rationale for this exception is that individuals who pay for items out-of-pocket, instead of going through insurance, should have the right to keep the details of such payments private.
What is 45 CFR 164.522 a? Terminating a Restriction
A provider may terminate a restriction under several circumstances. A provider may terminate a restriction if the patient agrees to or requests the termination in writing, or, if the individual orally agrees to the termination and the oral agreement is documented.