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Hi Folks:

I have a plea for help from fellow Kossacks here regarding HIPAA or insurance laws. Here's the backstory:

Economic tough times, expensive healthcare and all that (see also: 318,297 diaries over the last twelve months)...low and behold I've ended working retail here in Pennsylvania in order to get a bit of cash and some benefits. The position is Union, so the benefits have been excellent...excellent, that is, until our union renegotiated our contract with the Company. Now healthcare will start to cost real money with real deductibles. Yeah...I know, I know...it had to happen sometime, right? I guess so...I'm pretty resigned to it, though $12 an hour is starting to look REALLY particularly small.

More over the fold:

So what's the problem? The problem is our union - who provides our benefits through Independence Blue Cross (third party administered by Keystone Health Plans East)has just asked us to fill out a Personal Health Profile. Wait...they didn't actually ask us to do it. They told us if we didn't submit it we would be forced to pay a $10 monthly penalty. The Personal Health Profile is supposed to benefit us...they'll be able to tell if we have certain risk factors, and make health recommendations which allow us to proactively manage our lifestyles. It's so catchy it's almost awesome. "Proactively manage our lifestyles to improve our health." It's a new paradigm, is what it is. Tell us everything about yourself, and we'll give you some health advice. (Which you shouldn't follow without your doctor's okay, cause after all, we ain't doctors, we're union reps. But tell us all your private details anyway, 'cause having lots of information about you is cool.)  

So what do they want me to tell them? Typical stuff - weight, height, waist measurement, blood pressure, cholesterol, non/smoker, non/drinker, list of conditions of you may have been diagnosed with and, among loads of other personal stuff....wait for it....mental health questions. ("Do you get angry when someone says you've had too much to drink? How angry do you get, on a scale of 1 to 5?")   So, if I opt not to tell them these things, they're gonna hit me with a $10 fee.

Can they do that? Anyone? Anyone?
Help!

Originally posted to Everest42 on Sat Feb 06, 2010 at 07:51 AM PST.

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Comment Preferences

  •  pay the $10 (3+ / 0-)
    Recommended by:
    Fabian, Losty, KelleyRN2

    fuck that nonsense.

    People are upset Obama hasn't solved all the problems yet. C'mon, he's only been in office one year...the man went to Harvard, not Hogwarts. - Wanda Sykes

    by Cedwyn on Sat Feb 06, 2010 at 07:59:18 AM PST

  •  Sorry my answer is so general (3+ / 0-)
    Recommended by:
    Catte Nappe, Fabian, lordcopper

    This type of invasion of privacy is becoming quite common in the odd world of group health insurance. Most phrase it as optional and say the monthly charge is actually a discount for those who comply. Let's hope someone with knowledge in this area can cite specifics and advise you.

  •  Yes. (5+ / 0-)

    Your union negotiated for a service. These are the conditions of providing the service, i.e. the profile or the $10.

    The profile provides the provider with a risk assessment tool for the insured cohort. The $10 is, in effect, a premium "premium" to compensate for the unknown risk factors in those declining the profile.

    It's pretty common these days for providers to contact enrollees (telephone & mail, in my experience) with certain risk factors to discuss preventative measures.  These are not necessarily medically ignorant folks, and I've had several who have made recommendtions I've taken to heart.

    I'm curious as to why you think a union is a first defense against obtaining personal data.

    •  not quite (3+ / 0-)
      Recommended by:
      Andiamo, Everest42, Losty

      It's pretty common these days for providers to contact enrollees (telephone & mail, in my experience) with certain risk factors to discuss preventative measures.  These are not necessarily medically ignorant folks, and I've had several who have made recommendations I've taken to heart.

      My experience has been that the health insurance companies look at how you're using their product and then call or write you with health advice based on that information. For example, if your insurance is paying for Lipitor prescriptions, they know you have a cholesterol issue. If you get Glucophage, they know you have diabetes. And so on.

      Advice based on that information is fine and, as you say, may in fact be helpful.  But, and this is important, it's based on information that the insurance company already knows.

      Filling out a health survey is a little different -- and the fear is that if you reveal something in the health survey that the insurance company doesn't already know about that there will be adverse consequence.  To me, that is a rational fear.

      •  I agree, but in the diarist's circumstance there (0+ / 0-)

        is no history for the provider, and they are trying to establish a baseline. You're correct, over time historical data will accumulate (even for the $10 payers).

        The critical factors going forward in the diarist's instance will be the effect on coverage of major claims by cohort members (which, of course, is related to cohort size).

        •  This is common (0+ / 0-)

          in my experience

          Besides a realistic appraisal of your current health might help pattern some futute diagnostics for preventive measures you could take

          I see no real problem

          Be proactive

          Exercise more, eat less, live healthy

  •  In healthcare in the past, it used to be a one- (2+ / 0-)
    Recommended by:
    Catte Nappe, Fabian

    sized fits all approach. We've (psychologists and others in the field) been working with the industry to get them to 'see the light' that everyone is an individual and only individualized/tailored plans work.

    So, for example if you are a 35 year old male, with diabetes and your neighbor is, what might be impactful for you might not be for them. One of the ways in which targeted interventions can happen is by having more information.

    With HIPPA and the like, the benefits are worth it.

  •  Companies have been doing this for (1+ / 0-)
    Recommended by:
    Everest42

    a decade (maybe more) now. I keep waiting for the first privacy-violation lawsuit.

    Anyway, these things are not done to help with your health -- I've never seen a single study showing any benefit from these corporate big-brother "health" study.

    They're done to make the employees feel the heel. So they know the company has the goods on them, to demoralize them, to make them feel small.

    And it works.

    •  They use choices in health plans (0+ / 0-)

      to decide who to lay off..  

      http://en.wikipedia.org/...

      Signaling games
      From Wikipedia, the free encyclopedia
      Jump to: navigation, search
      An extensive form representation of a signalling game

      Signalling games are dynamic games with two players, the sender (S) and the receiver (R). The sender has a certain type, t, which is given by nature. The sender observes his own type while the receiver does not know the type of the sender. Based on his knowledge of his own type, the sender chooses to send a message from a set of possible messages M = {m1, m2, m3,..., mj}. The receiver observes the message but not the type of the sender. Then the receiver chooses an action from a set of feasible actions A = {a1, a2, a3,...., ak}. The two players receive payoffs dependent on the sender's type, the message chosen by the sender and the action chosen by the receiver [1][2]. A related game is a screening game where rather than choosing an action based on a signal, the receiver gives the sender proposals based on the type of the sender, which the sender has some control over.
      Contents
      [hide]

         * 1 Costly versus cost-free signaling
         * 2 Perfect Bayesian equilibrium
               o 2.1 Definition of perfect Bayesian equilibrium of the signaling game
                     + 2.1.1 Requirement 1
                     + 2.1.2 Requirement 2
                     + 2.1.3 Requirement 3
                     + 2.1.4 Requirement 4
         * 3 Applications of signaling games
               o 3.1 Philosophy
               o 3.2 Economics
               o 3.3 Biology
         * 4 See also
         * 5 References

      [edit] Costly versus cost-free signaling

      One of the major uses of signaling games both in economics and biology has been to determine under what conditions honest signaling can be an equilibrium of the game. That is, under what conditions can we expect rational people or animals subject to natural selection to reveal information about their types?

      If both parties have coinciding interest, that is they both prefer the same outcomes in all situations, then honesty is an equilibrium. (Although in most of these cases non-communicative equilbria exist as well.) However, if the parties interests do not perfectly overlap, then the maintenance of informative signaling systems raises an important problem.

      Consider a circumstance described by John Maynard Smith regarding transfer between related individuals. Suppose a signaler can be either starving or just hungry, and she can signal that fact to another individual which has food. Suppose that she would like more food regardless of her state, but that the individual with food only wants to give her the food if she is starving. While both players have identical interests when the signaler is starving, they have opposing interests when she is only hungry. When the signaler is hungry she has an incentive to lie about her need in order to obtain the food. And if the signaler regularly lies, then the receiver should ignore the signal and do whatever he thinks best.

      Determining how signaling is stable in these situations has concerned both economists and biologists, and both have independently suggested that signal cost might play a role. If sending one signal is costly, it might only be worth the cost for the starving person to signal. The analysis of when costs are necessary to sustain honesty has been a significant area of research in both these fields.
      [edit] Perfect Bayesian equilibrium

      The equilibrium concept that is relevant for signaling games is Perfect Bayesian equilibrium. Perfect Bayesian equilibrium is a refinement of Bayesian Nash equilibrium, which is an extension of Nash equilibrium to games of incomplete information. Perfect Bayesian equilibrium is the equilibrium concept relevant for dynamic games of incomplete information.
      [edit] Definition of perfect Bayesian equilibrium of the signaling game

      A sender of type tj sends a message m * (tj) in the set of probability distributions over M. (m(tj) represents the probabilities that type tj will take any of the messages in M.) The receiver observing the message m takes an action a * (m) in the space of probability distributions over A.
      [edit] Requirement 1

      The receiver must have a belief about which types can have sent message m. These beliefs can be described as a probability distribution μ(ti | m), the probability that the sender has type ti if he chooses message m. The sum over all types ti of these probabilities has to be 1 conditional on any message m.
      [edit] Requirement 2

      The action the receiver chooses must maximize the expected utility of the receiver given his beliefs about which type could have sent message m, μ(t | m). This means that the sum

      \sum_{t_i} \mu(t_i|m)U_R(t_i,m,a)

      is maximized. The action a that maximizes this sum is a * (m).
      [edit] Requirement 3

      For each type, t, the sender may have, the sender chooses to send the message m * that maximizes the sender's utility US(t,m,a * (m)) given the strategy chosen by the receiver, a * .
      [edit] Requirement 4

      For each message m the sender can send, if there exists a type t such that m * (t) assigns strictly positive probability to m (i.e. for each message which is sent with positive probability), the belief the receiver has about the type of the sender if he observes message m, μ(t | m) satisfies the equation (Bayes rule)

      \mu(t|m) = p(t)/\sum_{t_i} p(t_i)

      The perfect Bayesian equilibria in such a game can be divided in three different categories, pooling equilibria, semi-pooling (also called semi-separating), and separating equilibria. A pooling equilibrium is an equilibrium where senders with different types all choose the same message. A semi-pooling equilibrium is an equilibrium where some types of senders choose the same message and other types choose different messages. A separating equilibrium is an equilibrium where senders with different types always choose different messages. Therefore, if there are more types of actors than there are messages, the equilibrium can never be a separating equilibrium (but may be semi-separating equilibria).
      [edit] Applications of signaling games

      Signaling games describe situations where one player has information the other player does not have. These situations of asymmetric information are very common in economics and behavioral biology.
      [edit] Philosophy

      The first known use of signaling games occurs in David K. Lewis' Ph. D. dissertation (and later book) Convention.[3] Replying to W.V.O. Quine,[4][5] Lewis attempts to develop a theory of convention and meaning using signaling games. In his most extreme comments, he suggests that understanding the equilibrium properties of the appropriate signaling game captures all there is to know about meaning:

         I have now described the character of a case of signaling without mentioning the meaning of the signals: that two lanterns meant that the redcoats were coming by sea, or whatever. But nothing important seems to have been left unsaid, so what has been said must somehow imply that the signals have their meanings (Lewis 1969, 124).

      The use of signaling games has been continued in the philosophical literature. Other have used evolutionary models of signaling games to describe the emergence of language. Work on the emergence of language in simple signaling games includes models by Huttegger,[6] Grim, et al.,[7] Skyrms,[8][9] and Zollman[10]. Harms,[11][12] and Huttegger,[13] have attempted to extend the study to include the distinction between normative and descriptive language.
      [edit] Economics

      The first application of signaling games to economic problems was Michael Spence's model of job market signaling[14]. Spence describes a game where workers have a certain ability (high or low) that the employer does not know. The workers send a signal by their choice of education. The cost of the education is higher for a low ability worker than for a high ability worker. The employers observe the workers education but not their ability, and choose to offer the worker a high or low wage. In this model it is assumed that the level of education does not cause the high ability of the worker, but rather, only workers with high ability are able to attain a specific level of education without it being more costly than their increase in wage. In other words, the benefits of education are only greater than the costs for workers with a high level of ability, so only workers with a high ability will get an education.
      [edit] Biology

      Valuable advances have been made by applying signaling games to a number of biological questions. Most notably, Alan Grafen's (1990[15]) handicap model of mate attraction displays. The antlers of stags, the elaborate plumage of peacocks and birds of paradise, and the song of the nightingale are all such signals. Grafen’s analysis of biological signaling is formally similar to the classic monograph on economic market signaling by Michael Spence [16]. More recently, a series of papers by Getty [17] [18] [19] [20] shows that Grafen’s analysis, like that of Spence, is based on the critical simplifying assumption that signalers trade off costs for benefits in an additive fashion, the way humans invest money to increase income in the same currency. This assumption that costs and benefits trade off in an additive fashion might be valid for some biological signaling systems, but is not valid for multiplicative tradeoffs, such as the survival cost – reproduction benefit tradeoff that is assumed to mediate the evolution of sexually selected signals.

      Charles Godfray (1991[21]) modeled the begging behavior of nestling birds as a signaling game. The nestlings begging not only informs the parents that the nestling is hungry, but also attracts predators to the nest. The parents and nestlings are in conflict. The nestlings benefit if the parents work harder to feed them than the parents ultimate benefit level of investment. The parents are trading off investment in the current nestlings against investment in future offspring.

      Pursuit deterrent signals have been modeled as signaling games (Yachi, 1995[22]). Thompson's gazelles are known sometimes to perform a 'stott', a jump into the air of several feet with the white tail showing, when they detect a predator. Alcock and others have suggested that this action is a signal of the gazelle's speed to the predator. This action successfully distinguishes types because it would be impossible or too costly for a sick creature to perform and hence the predator is deterred from chasing a stotting gazelle because it is obviously very agile and would prove hard to catch.
      [edit] See also

         * Cheap talk
         * Extensive form game
         * Signalling (economics)
         * Signalling theory
         * Solution concept
         * Game theory

      [edit] References

        1. ^ Gibbons, Robert (1992) A Primer in Game Theory, Harvester Wheatsheaf ISBN 0-7450-1159-4
        2. ^ Osborne, M.J. and Rubenstein, A. (1994) A Course in Game Theory, MIT Press ISBN 0-262-65040-1
        3. ^ Lewis, D.: 1969, Convention. A Philosophical Study, Harvard University Press, Harvard, Mass.
        4. ^ Quine, W.v.O (1936) "Truth by Convention" in Philosophical Essays for Alfred North Whitehead pp 90-124. Longmans, Green & Co. London (ISBN 0-8462-0970-5, for 1967 Russel and Russel Publishers reprinting)
        5. ^ Quine, W.v.O (1960) "Carnap and Logical Truth" Synthese 12(4):350-374.
        6. ^ Huttegger, S. M. (2007) "Evolution and the Explanation of Meaning." Philosophy of Science 74:1-24
        7. ^ Grim, P., T. Kokalis, A. Alai-Tafti, N. Kilb, and Paul St. Denis. (2001) "Making Meaning Happen." Technical Report #01-02, Stony Brook: Group for Logic and Formal Semantics, SUNY, Stony Brook.
        8. ^ Skyrms, B. (1996) Evolution of the Social Contract. Cambridge: Cambridge University Press.
        9. ^ Skyrms, B. (2000) "Stability and Explanatory Significance of Some Simple Evolutionary Models." Philosophy of Science 67:94–113.
       10. ^ Zollman, K. J. S. (2005) "Talking to Neighbors: The Evolution of Regional Meaning." Philosophy of Science 72:69–85.
       11. ^ Harms, W. F. (2000) "Adaption and Moral Realism." Biology and Philosophy 15:699–712.
       12. ^ Harms, W. F. (2004) Information and Meaning in Evolutionary Processes. Cambridge: Cambridge University Press.
       13. ^ Huttegger, S. M. (2005) Evolutionary Explanations of Normative and Descriptive Statements, Erkenntnis 66: 409-436.
       14. ^ Spence, A.M. (1973) Job Market Signaling, Quarterly Journal of Economics. 87:355-374.
       15. ^ Grafen, A. (1990) Biological signals as handicaps. Journal of Theoretical Biology 144:517-546.
       16. ^ Spence, A.M. (1974) Market Signaling, Information Transfer in Hiring and Related Processes, Harvard University Press
       17. ^ Getty, T. (1998) Handicap signalling: when fecundity and viability do not add up. Anim. Behav. 56, 127–130
       18. ^ Getty, T. (1998) Reliable signalling need not be a handicap. Anim. Behav. 56, 253–255
       19. ^ Getty, T. (2002) Signaling health versus parasites. Am. Nat. 159,363–371
       20. ^ Getty. T (2006) Sexually selected signals are not similar to sports handicaps. Trends Ecol. & Evol 21, 83-88
       21. ^ Godfray, H.C.J. (1991) Signalling of need by offspring to their parents. Nature 352:328–330.
       22. ^ Yachi, S. (1995) How can honest signalling evolve? The role of the handicap principle. Proceedings of the Royal Society of London, B262:283–288.

  •  Lie to a thief. (0+ / 0-)

    I just upgraded internet speed. Now I can be late to the best diaries, faster.

    by mississippi boatrat on Sat Feb 06, 2010 at 08:17:52 AM PST

  •  Are they going to charge $10, or are they "not" (1+ / 0-)
    Recommended by:
    Everest42

    going to give you $10?  The way I've seen this played is they usually offer a $10 "rebate" if you complete the profile.  I've never seen a situation where you're "punished" for not completing it.

    "He that troubleth his own house shall inherit the wind."

    by lordcopper on Sat Feb 06, 2010 at 08:56:12 AM PST

    •  An additional $10 will be (1+ / 0-)
      Recommended by:
      lordcopper

      deducted from payroll and paid to the union on a weekly basis. ($2.49 a week, or some such #). Everyone I've spoken to agrees they have never seen a situation where a punishment can result (as opposed to reversing it into a benefit/rebate).

      Sorry for few responses - digging out from under a foot of snow...limited time to comment.

  •  They might be able to do this if.... (2+ / 0-)
    Recommended by:
    Catte Nappe, politicalstu

    ...the Union negotiated a contract that provides for this type of thing.  There are all sorts of "managed care" proposals that require health profiles of the persons covered.

    I have an insurance company that maintains a healthcare profile on me, similar to this.  What I did was first find out the "privacy policy" of the insurer.  I contacted the privacy office and found out that you could request in writing that your information not be shared with other companies and affiliates. I told them in writing not to share it with anyone.  Every 6 months I have to renew my request.

    Then, after I did that I updated my profile.

    That's my two cents....

    •  Not the case - (0+ / 0-)

      everyone in the company (union employees) recieves coverage - no pre-existing conditions, etc. Nothing has ever been requested like this before.

    •  And for life insurance (0+ / 0-)

      I had a nurse come to my home, sent by the insurer, to do a complete medical history on me

      Plus draw blood, plus she had her own scale, and some other stuff

      It was invasive, but so what, I wanted their life policy

      No regrets

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