Consumers of health and life insurance should understand that prescriptions purchased at the drugstore could harm your chances of getting insurance coverage. According to BusinessWeek,
An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.
Health experts, like Doctor Kate Atkinson of Amherst, worry that insurance companies make incorrect assumptions by analyzing prescription records, because many drugs have multiple uses. Dr. Atkinson told the Washington Post,
"I had a patient on Amitriptyline for migraines and they were denied life insurance because it’s also an antidepressant. I had to explain it wasn’t being used for depression." Another patient was on Prozac — not for depression, but for menopausal hot flashes. "I wrote an appeal letter, and they still wouldn’t give it to her."
There's more:
Federal law entitles all consumers to a free annual copy of their medical report file. If you've never heard of Ingenix, Inc. and Milliman, Inc., the two major companies providing this technology to insurers, it's not your fault. An investigation in 2008 by the Federal Trade Commission found that,
"the two companies supplying these pharmacy profiles violated Federal law for years by keeping the system hidden from consumers."
To explain, health and life insurance companies purchase consumer data and information from technology providers. Whereas the major credit reporting bureaus TransUnion, Equifax, and Experian collect information from banks, credit card companies, and other financial service providers, there are two main "credit reporting agencies" for health care and medical information - Ingenix, Inc. and Milliman, Inc.
The Washington Post reports that, amid growing privacy concerns, these "medical reports" continue to "be drawn from databases containing prescription drug records on more than 200 million Americans." Ingenix, Inc. sells the Medpoint technology product and Milliman, Inc. sells the IntelliScript product. How do these technology products work?
"When an insurer makes an online query about an applicant, Ingenix or Milliman’s servers scour the data and within minutes or less return reports to a central server at the company. The server aggregates the information going back as far as five years, including the drugs and dosages prescribed, dates filled and refilled, the therapeutic class and the name and address of the prescribing doctor. Then comes the analysis. Ingenix’s MedPoint tool provides insurers a "pharmacy risk score," or a number that represents an "expected risk" for a group of people, such as 30- to 35-year-old women who have taken prescription drugs...Higher scores imply higher medical costs."
By mining the extensive databases of prescription drug histories kept by pharmacy benefit managers (PBMs), which are companies that help insurers process drug claims, Ingenix, Inc. and Milliman, Inc. are able to build detailed medical profiles on every patient. How fast does consumer medical information travel from the drugstore register to the servers of Ingenix, Inc. and Milliman, Inc.? The Washington Post says that,
"Ingenix, for instance, has servers in the PBM data centers, updating the drug files as frequently as once a day, says John Stenson, senior vice president of consulting for Ingenix, which is a division of UnitedHealth Group. The corporation also owns UnitedHealthcare, the nation’s second-largest insurer."
So, Ingenix, Inc. and Milliman, Inc. literally have servers within the companies that process personal and corporate pharmacy claims. Of course, insurance companies are willing to pay to obtain this information because it allows them to increase the accuracy of their risk models and premium costs. The Minnesota-based Ingenix, Inc. earned $1.3 billion in sales in 2007. Concerned with the increasing usage of consumer medical information by insurance companies, the Federal Trade Commission opened investigations into Ingenix, Inc. (FTC link) and Milliman, Inc. (FTC link).
In February 2008, the Federal Trade Commission issued orders declaring that Ingenix, Inc.'s "MedPoint" and Milliman Inc.'s "IntelliScript" qualify as consumer reports under the Fair Credit Reporting Act. As such, Ingenix, Inc. and Milliman, Inc. must notify insurers that consumers that have been denied insurance on the basis of these reports have the right to request a copy of the report and that errors must be corrected. To be clear, under Federal law, the Fair Credit Reporting Act, all consumers are entitled to annual copies of their medical report files at no charge.
Specifically, what type of information do Ingenix, Inc. and Milliman, Inc. collect? According to the Federal Trade Commission complaint against Ingenix, Inc. (In the Matter of INGENIX, INC., A CORPORATION. DOCKET NO. C-4214),
"Ingenix Inc., operates MedPoint, a medical data collection and sales technology. The medical profile generated by MedPoint includes, but is not limited to, prescription drugs, including dosage and number of refills filled by the insurance applicant for the previous five years. It also includes for each drug, the name and address of the dispensing pharmacy, as well as the name and address of the prescribing doctor, including specialty medical practice. The medical profile generated by MedPoint analyzes the individual’s prescription drug history, and provides, based on that analysis, potential medical conditions that may be present and predictive scores for the individual."
Importantly, MedPoint doesn't just collect patient medical data, the software actually executes an analysus and provides a report of "potential medical conditions that may be present," as well as "predictive scores" for future illnesses! Under the regulations of the Fair Credit Reporting Act, Ingenix, Inc. is required to provide free annual medical reports for all consumers contained in its files. Additionally, according to the Federal Trade Commission complaint against Milliman, Inc. (In the Matter of MILLIMAN, INC., A CORPORATION. DOCKET NO. C-4213).
"Milliman operates IntelliScript, a data aggregation service that provides individual medical profiles, including, but not limited to, prescription drug purchase histories of insurance applicants, to health and life insurance companies. The medical profile generated by IntelliScript includes, but is not limited to: all prescription drugs, including dosage and number of refills filled by the insurance applicant for the previous five years. It also includes, for each drug, the name and address of the dispensing pharmacy, as well as the name and address of the prescribing doctor, including medical specialty. The medical profile generated by IntelliScript analyzes the individual’s prescription drug history and provides a "map" of the risk levels associated with each drug, based on information provided by the insurer."
Again, notice that the medical profile that IntelliScript creates on each consumer includes both a prescription drug history and a corresponding analysis of the consumer's present and future illnesses. Likewise, under the regulations of the Fair Credit Reporting Act, Milliman, Inc. is required to provide free annual medical reports for all consumers contained in its files. Joy Pritts, research professor at Georgetown University’s Health Policy Institute tells the Washington Post that consumers have legitimate concerns about Ingenix, Inc. and Milliman, Inc. constructing medical report files on millions of Americans,
"Most people don’t even know these organizations exist. Unfortunately the Federal health privacy rule does not cover many of them...As health care moves into the digital age, there are more and more companies holding vast amounts of patients’ health information...The lack of transparency with how all of this works is disturbing."
Under Federal law, all consumers are entitled to annual copies of their medical report files at no charge. But, with millions of dollars in technological infrastructure investments supporting Ingenix's "MedPoint" and Milliman's "IntelliScript" products, what technology do these companies offer for consumers to request, review, and appeal inaccurate information in their prescription medical report files? A telephone number and the U.S. Postal Service. That's right- there is no central, secure website by which consumers can request their free annual consumer medical report.
How do you request your medical report? Currently, you must contact each company individually. Even though your information is already sold and transferred online by Ingenix, Inc. and Milliman, Inc. to insurance companies, neither Ingenix, Inc. nor Milliman, Inc. provides a centralized, secure website for you to request, review, or dispute inaccuracies on your medical report file. The two options for obtaining a free annual copy of your medical report file from Ingenix, Inc. are:
- CALL – To obtain a free copy of your consumer medical report file, U.S. residents may call Ingenix, Inc. by telephone at 1-888-206-0335. Please be prepared to provide the following information: Full Name (please spell your name if you’re leaving a message), Mailing Address (e-mail or fax if you’d like to receive your report via e-mail or fax), Date of birth, Last four digits of SSN, Insurance company to which you applied for insurance.
- MAIL – U.S. residents can request a copy by writing to Ingenix, Inc. at the following address: "MedPoint Compliance, Ingenix, Inc., 2525 Lake Park Blvd, West Valley City Utah 84120."
The two options for obtaining a free annual copy of your medical report file from Milliman Inc. are:
- CALL – To obtain a free copy of your consumer medical report file, U.S. residents may call Milliman Inc. by telephone at 1-877-211-4816. Please be prepared to provide the following information: Full Name (please spell your name if you’re leaving a message), Mailing Address (e-mail or fax if you’d like to receive your report via e-mail or fax), Date of birth, Last four digits of SSN, Insurance company to which you applied for insurance.
- MAIL – U.S. residents can request a copy by writing to Milliman, Inc. at the following address: "Milliman, Inc. IntelliScript, 15800 Bluemound Road, Suite 400, Brookfield, WI 53005."
Federal law guarantees that every consumer is entitled to a free annual copy of their medical report file stored by the Ingenix, Inc. and Milliman, Inc. Have you ever checked your free medical report file from Ingenix, Inc. and Milliman, Inc.? If not, please recommend this diary to help spread the word about Ingenix, Inc. and Milliman, Inc. and to educate insurance consumers.