Insurance Companies and Hospitals Use Personal Data to Deny Services

Wednesday, January 21, 2009 by: Joanne Waldron
Tags: health insurance, health news, Natural News

(NewsTarget) For those people looking for one more reason to stick to their health resolutions for the New Year, The Washington Post reports that health and life insurance companies use a type of consumer health "credit report" that is derived from databases containing the prescription medication records on over 200 million Americans. In fact, some insurers are already testing information systems that contain information about the laboratory test results on patients. Previously, in order to determine insurability, insurance companies had to rely on records obtained directly from physician's offices. Insurers these days, however, rely on records that are obtained electronically at a very low cost (currently about 15 bucks), and these records are often used to deny people health insurance.

Profiles Kept of Patient Prescription Information

Two of the companies that compile health data about consumers are Wisconsin-based Milliman IntelliScript and a Minnesota-based company known as Ingenix. Some of the information stored about each consumer includes a history of five years worth of prescription medications and dosages, dates they were filled/refilled, the therapeutic classes of the drugs, and the name and address of the doctor who prescribed each medication. From this information, each consumer is assigned an expected risk score (kind of like a credit rating, except instead of measuring one's credit worthiness, it measures one's expected health risk).

Doctors Fail to Warn Patients About Insurance Profiling Systems

It is doubtful that most doctors bother to warn their patients that taking optional or unnecessary medications could make it impossible or very expensive to get health insurance. In fact, most patients mistakenly believe that it is illegal for companies to sell private consumer health information. Nothing could be further from the truth.

For instance, according to the aforementioned Washington Post article, one doctor reported that she prescribed a drug called Amitriptyline for migraine headaches, and the patient was then denied life insurance due to the fact the medication was also an antidepressant. The article also asserts that insurers also leap to conclusions about patients' probable health outcomes if they notice that patients are taking the highest possible dosage of, say, a cholesterol medication.

Taking Dangerous Drugs Can Raise Health Risk Score

According to the Washington Post article, Milliman's Intelliscript assigns one of three color codes to drugs. A red code, for example, means the drug has the greatest risk (i.e. AIDs or cancer drugs). Interestingly enough, those who pay for drugs in cash often aren't included in the databases.

Patients Have a Right to Review Information on File

According to an article by consumer advocate Clark Howard, a patient has a right to review his/her health "credit report," under
new federal laws. Currently, one may obtain his/her own Ingenix report by calling MedPoint Compliance at 888-206-0335. IntelliScript reports may currently be obtained by calling 877-211-4816. MIB, Inc. will provide information to consumers for free (on an annual basis); the number to call is 866-692-6901.

Beware of Scam Sites

Clearly, not all sites claiming to track consumer health information are legitimate ones. AbortionTracker.com claims to have the medical records of all women who have had abortions, and this site is a complete sham. Likewise, a site called AidsMapper.com, which claims to have the medical records of all people with AIDS, is a hoax site.

Hospitals Perform "Wallet Biopsies" on Patient Financial Data

As if insurance companies using health "credit score" information isn't bad enough, now many hospitals are getting into the act, as well. According to an article in Business Week, many hospitals are actually purchasing patient credit data - a procedure is known in the industry as a "wallet biopsy" - in order to determine what course of treatment a patient can afford. If a patient can't afford a certain course of treatment, the patient isn't even told about the possibility of the treatment. Some of the data that hospitals use to determine what a patient can afford includes credit card limits, credit scores and, believe it or not, IRA balances. Yes, hospitals actually do try to get people to withdraw money from IRA accounts in order to receive necessary medical services.

Advice to Patients Who Can't Cough up Cookies

According to an article by consumer advocate Clark Howard, however, there is a way for patients to fight back. Many hospitals have a non-profit status, and these hospitals receive "massive subsidies from taxpayers," according to Howard, in exchange for their promise to provide charitable care. Clark Howard recommends that if a patient feels that he/she (or a family) member isn't getting appropriate care, just see the hospital administrator and threaten to challenge the hospital's tax-exempt status.

It is a shame that hospitals don't check out their own staff members as well as they check out the financial data of their patients prior to treatment. Luckily, there are plenty of online resources to assist patients in checking out their doctors. For example, deadbeat doctors who failed to pay back school loans are listed in an online database, and doctors with criminal cases against them are also listed in an online database. Of course, given the current state of affairs with the American medical system, the best course of action seems to be to take whatever measures are necessary to preserve one's health, thus avoiding unnecessary hospital visits and preserving one's own medical and financial privacy.

About the author

Joanne Waldron is a computer scientist with a passion for writing and sharing health-related news and information with others. She hosts the Naked Wellness: The Gentle Health Revolution forum, which is devoted to achieving radiant health, well-being, and longevity.