Skip to main content

What pre-existing conditions do you and your children have? Just as financial companies rely on "credit reports" to establish credit for customers, insurance companies utilize "medical reports" to assess the health, determine the insurability, and set the price for insurance applicants and policyholders.

Most consumers and even many insurance agents are unaware that Humana, UnitedHealth Group , Aetna (AET), Blue Cross plans, and other insurance giants have ready access to applicants’ personal histories. These online reports, available to insurers in seconds from little-known intermediary companies, typically include voluminous medical and personal information. The reports may also provide a numerical score predicting what a person may cost an insurer in the future.

Using information from these medical report files, insurance companies can charge you higher premiums or terminate your coverage altogether. (For example, "Denied Insurance Because of a Medical Coding Error in Her MIB Report")

Few consumers realize that the Medical Information Bureau Inc. (MIB), Ingenix Inc. and Milliman Inc. have personal medical report files on them.  Like the credit-reporting agencies Experian, TransUnion, and Equifax, these "nationwide specialty consumer reporting agencies" monitor virtually every aspect of a person’s life.  

The health insurance lobbying group America's Health Insurance Plans (AHIP) says the MIB, founded more than a century ago, operates the most extensive database of medical information on individuals who have previously applied for health, life, disability income, critical illness and long-term care insurance in North America."

The Federal Trade Commission warns that your medical report files may include both medical and non-medical information about you.  For instance, personal data collected by the MIB includes medical conditions, your credit report history, driving records, criminal activity, drug use, sexual orientation, lifestyle activities, international travel, participation in hazardous sports, and personal or family genetic history.  Using information from these medical report files, insurance companies can charge you higher premiums, deny you coverage, or terminate your policy altogether.

In fact, failing to check your medical report can be costly; errors or omissions within individual medical report files can cause applicants to be rejected outright, pay higher policy premiums, or suffer outright rescission of coverage! Even if you are in good health, an error in your medical report file may impair your ability to obtain affordable insurance.  Take the story of Sheila from Gulfport, Mississippi, who spent her 401(k) savings on out of pocket healthcare costs after being repeatedly denied for individual health insurance,

Consumer Reports Health’s Cover America Tour realized the impact of MIB when we visited Sheila in Gulfport, Miss., the day after her 50th birthday.

Sheila was surprised when she was rejected for an individual health-insurance policy by three different companies. She was even more shocked when she learned why: Her record with MIB listed her as having a history of Chronic Obstructive Pulmonary Disease (COPD). Sheila does suffer from asthma, but COPD is supposed to be used to indicate more severe diseases of the lungs, such as emphysema or severe bronchitis. No company would insure her with this damaging mark on her record.

Sheila eventually traced the problem to a coding disparity at her doctor’s office. She says letters and phone calls to both her doctor and MIB have been to no avail, and the problem remains uncorrected on her record, effectively blocking her from obtaining individual health coverage.

Or, there's the Consumer Reports story of Michael from Abingdon, Virginia, who first sought to buy individual insurance in 2003 after leaving a federal regulatory position and exhausting his COBRA benefits, but was distressed to learn that he was completely uninsurable.

"I’ve been diagnosed with diabetes but I’m perfectly healthy," Michael says. "I follow a strict diet. I’m not overweight and I walk 20 miles a week. I check my glucose levels regularly. I take oral medication, and my diabetes is completely under control."

His problems result from the practice called medical underwriting. It’s illegal nationwide for insurers to discriminate against people in group plans on the basis of their health. But in all but a handful of states, medical underwriting for individual plans is allowed."

If the insurance company doesn’t like what it sees, in many states, it can flatly turn you down, quote you a much higher premium, or offer you insurance that covers everything except the health conditions it doesn’t like. Applicants for individual health insurance quickly learn that although they consider themselves healthy, insurers may not.  Health Net, for instance, lists "diabetes, once diagnosed, all treatments" on its list of "declinable conditions." Diabetes is one of a lengthy list of conditions that will automatically get you into state high-risk pools, special insurance products maintained by 34 states for people who can’t find themselves disqualified for individual health insurance on the open market.

"It sounds harsh, but insurance is an actuarial science that looks at the likelihood of something happening and what the cost will be," says Janet Trautwein, chief executive officer of the National Association of Health Underwriters. "When a diabetic does have complications, they are unbelievably expensive, and that’s why a diabetic is always turned down, even if they’re running marathons."  But conditions that most lay people would consider less serious than diabetes will also get you disqualified for individual health insurance. PacifiCare may decline anyone who takes prescription medications for high blood pressure, acid reflux, asthma, migraines, arthritis, or depression. Aetna won’t insure anyone who’s had a hip or knee replacement.

An investigation in 2008 by the Federal Trade Commission found that two of these nationwide specialty consumer reporting agencies supplying these medical profiles, Ingenix Inc. and Milliman Inc., violated federal law for years by keeping the system hidden from consumers. But the FTC has merely required disclosure if prescription information causes denial of coverage or some other adverse action; the agency imposed no penalties.

(FTC Decision and Order against Ingenix, Inc. (2008))
(FTC Decision and Order against Milliman, Inc. (2008))

Remember, the new health care reform laws in the Patient Protection and Affordable Care Act don’t go in effect until 2014. All insurance applicants and policyholders should request an annual copy of their medical report files from the nationwide specialty nationwide consumer reporting agencies to ensure they aren’t overpaying for insurance or in danger of policy rejection or rescission for pre-existing conditions or errors.

Originally posted to B Dizzle on Thu Apr 08, 2010 at 07:06 AM PDT.

EMAIL TO A FRIEND X
Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags

?

More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  Holy shit. I always thought that episode in (5+ / 0-)

    Seinfeld where Elaine can't get a doctor to see her because of her "file" was just a joke.

    Seriously, thank you for the info. I never knew I could view my health file. The added consumer data is just creepy.

    "Ignorance breeds monsters to fill up the vacancies of the soul that are unoccupied by the verities of knowledge." H Mann

    by the fan man on Thu Apr 08, 2010 at 07:13:23 AM PDT

    •  Elaine's File (4+ / 0-)

      OMG! hahah!  I never made the connection with Elaine's file in Seinfeld!

      I wonder if the "file" in the episode is her medical report file from one of these nationwide specialty consumer reporting agencies or the American Medical Association (AMA) Physician Masterfile Database?  The AMA file is also pretty creepy (but you, as a patient, cannot see it).  

      What is the American Medical Association Physician Masterfile database? And why is it so profitable for the AMA?

      The American Medical Association (AMA), founded in 1847 and incorporated 1897, is the largest association of physicians and medical students in the United States. Throughout its history, the AMA has been actively involved in a variety of medical policy issues, from Medicare and HMOs to public health, and climate change.

      The American Medical Association closely tracks the activities of physicians from medical school to death. In its Physician Masterfile, the AMA merges all of the information it has ever collected about physicians and the medical care they provide. The AMA began compiling physician data in 1906—the Physician Masterfile is now more than a century old and includes records for approximately 900,000 physicians, about two thirds of whom are not AMA members. Physician records are never removed from the AMA Physician Masterfile, even in the case of a physician’s death.

      In 2002, sales of licenses to the American Medical Association’s (AMA) Physician Masterfile generated $20 million in revenue for the organization. By 2007, sales of the AMA Physician Masterfile had reached $40 million per year.

      Orville and Wilbur Wright never needed a pilot's license...

      by B Dizzle on Thu Apr 08, 2010 at 07:27:10 AM PDT

      [ Parent ]

      •  Just unreal. I guess your life is just out there (4+ / 0-)
        Recommended by:
        tiponeill, Simplify, Dichro Gal, pantherq

        isn't it.

        From the episode:

        Attendant : The doctor will be with you in a moment.

        (Elaine looking at her medical chart)

        Elaine: Difficult ?

        Doctor: Elaine. You shouldn't be reading that. So tell me about this rash of yours.

        Elaine: Well it's , it's ..... You know I noticed that somebody wrote in my chart that I was difficult in January of 92 and I have to tell you that I remember that appointment exactly . You see this nurse asked me to put a gown on but it was a mole on my shoulder and I specifically wore a tank top so I wouldn't have to put a gown on. You know they're made of paper.

        Doctor: Well that was a long time ago. How about if I just erase it. Now about that rash ......

        Elaine: But it was in pen. You fake erased.

        Doctor: All right Miss Benes. This doesn't look to serious. You'll be fine.

        (Doctor writes in chart)

        Elaine: What are you writing Doctor?

        (Elaine sleeping in bed. Phone rings)

        Elaine: Hello.

        Guy: Is this Elaine Marie Benes ?

        Elaine: Yes. Who it this ?

        Guy: We are with the American Medical Association. Can you confirm the correct spelling of your last name? Is it B-e-n-e-s .

        Elaine: Yeah. What is this all about?

        Guy: Good bye.

        Elaine: Hello, hello?

        Guy: What?

        Elaine: Oh uh uh ...

        Guy: Get off the line. Were trying to make another call.

        "Ignorance breeds monsters to fill up the vacancies of the soul that are unoccupied by the verities of knowledge." H Mann

        by the fan man on Thu Apr 08, 2010 at 07:41:56 AM PDT

        [ Parent ]

        •  When did that episode air? (7+ / 0-)

          Federal Trade Commission Press Release from 1995


          June 21, 1995, 9:30 a.m.

          Nation's Largest Insurance Reporting Agency Agrees To Expand Consumer Rights

          MIB, based outside of Boston, is an organization with approximately 750 member insurance companies. It collects and furnishes information on consumers to all MIB members for use in the insurance underwriting process. In addition to an individual's credit history, data collected by MIB may include medical conditions, driving records, criminal activity, and participation in hazardous sports, among other facts. MIB's member companies account for 99 percent of the individual life insurance policies and 80 percent of all health and disability policies issued in the United States and Canada.

          Before the change in MIB rules, the rules stated that insurance companies did not need to abide by Fair Credit Reporting Act notification requirements if information from MIB's files was used only to alert members to the possible need for further investigation of an individual consumer.

          Apparantly, Elaine's pre-existing condition is "being too difficult"!  Which sounds crazy, but isn't to far fetched...

          MIB was organized in 1902 as a non-profit trade organization; today, MIB is registered as a not-for-profit trade association and roughly 750 insurance companies subscribe to its membership. MIB’s files don’t contain medical records, test results, or X-rays. Instead, each person’s file contains one or more codes that stand for a particular medical condition that has been reported for that person. There are codes that signify diabetes, heart problems, and drug use. Some codes are very detailed. For examples, one researched found that MIB had five codes for AIDS.

          Not all of the codes at the Medical Information Bureau are medical.  For example, MIB has five codes that indicate a dangerous lifestyle, including, "adverse driving records, hazardous sports, aviation activity, or homosexual lifestyle" These codes map to similar question on most life insurance forms.

          MIB is thus the official insurance agency gossip columnist. MIB helps make sure that if one life insurance company rejects a person on medical grounds, then other life insurance companies will be made aware of the ailment and reject that person.

          MIB has been the subject of ongoing controversy since the 1970’s, when its existence first became generally known. At the root of the controversy is the organization’s penchant for secrecy. For many years, insurance agencies consulted MIB without telling applicants about the files. MIB even had an unlisted phone number. Today, the secret continues, if to a lesser extent: MIB won’t release the list of codes it uses.

          In the past, says Privacy Journal publishers Robert Smith, MIB had codes that stood for "sexual deviance" and "sloppy appearance." MIB President Neil Day disagrees, but since MIB won’t release the list of conditions for which it has created codes, there is really no way to know for sure.

          Orville and Wilbur Wright never needed a pilot's license...

          by B Dizzle on Thu Apr 08, 2010 at 08:09:18 AM PDT

          [ Parent ]

          •  1996. Check this out, (6+ / 0-)

            this is really crazy:

            The American Medical Association’s recent resolution calls for adding a special code to identify "non-compliant patients" because, as Resolution 710 reads, "the stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction." The resolution, introduced by the Michigan Delegation on May 6, 2009, appears to be inspired by the Seinfeld episode entitled "The Package," which first aired on October 17, 1996.

            Did the AMA Steal Idea for Ungrateful Patient Resolution from Seinfeld?

            "Ignorance breeds monsters to fill up the vacancies of the soul that are unoccupied by the verities of knowledge." H Mann

            by the fan man on Thu Apr 08, 2010 at 08:21:25 AM PDT

            [ Parent ]

            •  WOW- AMA Stole the Code from Seinfeld! (4+ / 0-)

              WOWOWOW!!!  "This is gold, Jerry!  Gold!"

              Amazing find!  This out to be diaried...  No wonder the AMA was so willing to go along with the President's health insurance reform plan; the AMA is averaging $100 million per year in revenues by licensing the sale of patient/doctor medical information!

              Geez-  people flipped found out when they learned that Netflix released their 'anonymous movie data' to seed an online development contest.  Wonder if people will care that their doctors are secretly selling their personal medical interaction details to pharmaceutical and insurance companies?

              Most DOCTORS don't even know this is going on!!  And, the AMA is not working very hard to remind them!!!

              The results of a Kaiser Family Foundation research study showed that only 60% of physicians were aware that the American Medical Association is selling their information through the AMA Physician Masterfile Database, but 74% of physicians were opposed to the practice once they were so informed.

              Even worse, doctors were less informed about their ability to opt-out of having their practice-level data sold, according to an American Medical Association survey in January 2007, only about 10% to 15% of physicians were aware of the AMA’s Physician Data Restriction Program (PDRP); a second survey in late May showed that physician awareness had increased to 33%.

              Orville and Wilbur Wright never needed a pilot's license...

              by B Dizzle on Thu Apr 08, 2010 at 08:31:13 AM PDT

              [ Parent ]

  •  Insurance companies will be purging like mad (3+ / 0-)
    Recommended by:
    B Dizzle, Fabian, pantherq

    in these four years till the law goes into effect.

    If this doesn't get Americans to lose weight, eat right, stop smoking cancer sticks, exercise, limit cellphone use, and have their kids do the same, nothing will!

  •  MIB and annualmedicalreport.com (6+ / 0-)

    Thanks for the diary - I never knew about this stuff, though I guess I'm not surprised.

    But I have one concern.  You link to annualmedicalreport.com.  I notice that the MIB site also has free medical reports.  Is annualmedicalreport.com analogous to the spam sites that promise a free credit report, but aren't really free, or is it legitimate?

    •  Not really free. (4+ / 0-)
      Recommended by:
      sny, Fabian, Hens Teeth, Dichro Gal

      It appears to cost $30.  Look here, bottom of page where it says "order":

      https://www.annualmedicalreport.com/...

    •  annualmedicalreport.com is secure (5+ / 0-)

      The nationwide consumer reporting agencies the Medical Information Bureau Inc. (MIB), Ingenix Inc., and Milliman Inc. do NOT offer the ability to request your medical report disclosure file online!  While the instructions can indeed be found on the MIB site, they are merely directions to call a 1-800 number and leave your personal information on a voicemail.  (the same goes for Ingenix and Milliman).  So, a family of four trying to request their annual medical report files will need to make a total of 12 calls to 3 separate agencies just to obtain their files.  (and yes, the MIB keeps files on children who have insurance.)

      Under federal law, there is no "central source" for medical report files like there is for credit report files (eg, annualcreditreport.com).  Moreover, the 'free disclosure law' only covers the major Consumer Reporting Agencies (Experian, Equifax, and TransUnion) but not the dozens of smaller "nationwide specialty consumer reporting agencies" (as defined by FCRA Section 603(w)).

      All of the instructions for making a disclosure request are available at AnnualMedicalReport.com.  When I tried calling the 1-800 numbers directly, I didn't feel comfortable leaving all my personal data in an unknown mailbox (including date of birth and SSN).  I don't know about you, but I would rather trust SSL/ HTTPS security than a 'secure voicemail box.'  Although AnnualMedicalReport.com is a paid service, it was easy to do and allowed me to fill out one form and get all three of my reports from the nationwide specialty consumer reporting agencies.  

      According to the order page, "there are no long term contracts, no monthly charges, and no termination fees."  So, its just a one time fee (and I was only charged once).

      Orville and Wilbur Wright never needed a pilot's license...

      by B Dizzle on Thu Apr 08, 2010 at 07:55:13 AM PDT

      [ Parent ]

    •  Like the NY Times - Free to Read, Optional to Pay (1+ / 0-)
      Recommended by:
      Dichro Gal

      FYI- annualmedicalreport.com is a "secure online service" that allows people to request their medical report files through an online form.  But, you don't have to use the service...  

      There's very little information online about these nationwide specialty consumer reporting agencies and this website seems to be an authoritative source.  Is it surprising that the MIB doesn't want to publicize itself?

      Interestingly, you can read about your disclosure files on the corporate website of each of these nationwide specialty consumer reporting agencies.  But, you cannot make your request with them online.  You'll need to call their 1-800 numbers and leave your information in a voice mailbox.

      Orville and Wilbur Wright never needed a pilot's license...

      by B Dizzle on Thu Apr 08, 2010 at 08:02:39 AM PDT

      [ Parent ]

  •  Thanks for this (3+ / 0-)
    Recommended by:
    B Dizzle, stevej, Dichro Gal

    important stuff.  had no idea.

  •  Highly recommended (1+ / 0-)
    Recommended by:
    B Dizzle

    thanks

    The Teabaggers are the GOP base

    by stevej on Thu Apr 08, 2010 at 07:42:28 AM PDT

  •  "secure online service" (0+ / 0-)

    FYI- annualmedicalreport.com is a "secure online service" that allows people to request their medical report files through an online form.  But, you don't have to use the service...  

    There's very little information online about these nationwide specialty consumer reporting agencies and this website seems to be an authoritative source.  Is it surprising that the MIB doesn't want to publicize itself?

    Interestingly, you can read about your disclosure files on the corporate website of each of these nationwide specialty consumer reporting agencies.  But, you cannot make your request with them online.  You'll need to call their 1-800 numbers and leave your information in a voice mailbox.

    Orville and Wilbur Wright never needed a pilot's license...

    by B Dizzle on Thu Apr 08, 2010 at 08:01:21 AM PDT

  •  Great diary-- one of the most useful (1+ / 0-)
    Recommended by:
    imabluemerkin

    I've seen on DK in a while.  Thanks!

    Tipped and Recced!

    "Just because I'm skinny doesn't mean I'm not tough" --Barack Obama, Oct. 26, 2009

    by Pangloss on Thu Apr 08, 2010 at 08:08:22 AM PDT

    •  Thanks - Share the Knowledge! (1+ / 0-)
      Recommended by:
      imabluemerkin

      Thanks Pangloss!

      Please feel free to tell a friend (or 20) about these insurance consumer reporting agencies!

      Remember, the new health care reform laws in the Patient Protection and Affordable Care Act don’t go in effect until 2014. Until then, insurers can deny coverage to children and adults based upon pre-existing conditions.

      Orville and Wilbur Wright never needed a pilot's license...

      by B Dizzle on Thu Apr 08, 2010 at 08:11:33 AM PDT

      [ Parent ]

  •  If these reports are so comprehensive (0+ / 0-)

    ?

    Why isn't the Social Security Administration using them to assess applicant validity for their claims?

    I understand the SSI process is meant to dissuade applicants thorough  Kafkaesqe maneuvering but really, if it is good enough for for profit systems to use this information to deny claims shouldn't it stand to reason that SSI could use it to assess levels of disability?

    •  Federal Govt does use Choicepoint, Acxiom, etc.. (0+ / 0-)

      I'm not familiar with the SSI process, so I'm not specifically sure about assessing Social Security claims.  However, all consumers are entitled to request an annual copy of their Social Security Statement from the Social Security Administration.

      http://www.ssa.gov/...

      Form SSA-7004, Request for Social Security Statement, is used to get a record of your Social Security earnings history. When we receive your request, we will send you a Statement that shows your earnings year-by-year and give you estimates of benefit payments that you and your family may qualify for now or in the future.

      Orville and Wilbur Wright never needed a pilot's license...

      by B Dizzle on Thu Apr 08, 2010 at 09:18:39 AM PDT

      [ Parent ]

      •  I would prefer that they (0+ / 0-)

        quick dicking me around and allow the benefits I am entitled to and started paying into when I was 12. I started having a seizure disorder in 2002 and they have made me start the process all over again repeatedly every time I get too sick and miss sending in some bit of minutiae that they could just as easily garner from sources like that.

    •  doesn't this whole industry violate HIPAA? n/t (3+ / 0-)
      Recommended by:
      Tom Anderson, Hens Teeth, pantherq

      Texas is NO Bush League! LBJ, Lady Bird, Sully Sullenberger, Ike, Molly Ivins, Barbara Jordan, Ann Richards, Drew Brees -7.50,-5.59

      by BlackSheep1 on Thu Apr 08, 2010 at 11:16:59 PM PDT

      [ Parent ]

  •  Wow (0+ / 0-)

    I never knew that this medical information was kept and available to insurance companies. Thank you so much for providing this information.

    •  Spread the Knowledge (0+ / 0-)

      thanks revm3up! please feel free to tell a friend (or 20) about these insurance consumer reporting agencies!

      Remember, the new health care reform laws in the Patient Protection and Affordable Care Act don’t go in effect until 2014. Until then, insurers can deny coverage to children and adults based upon pre-existing conditions.

      Orville and Wilbur Wright never needed a pilot's license...

      by B Dizzle on Thu Apr 08, 2010 at 09:19:41 AM PDT

      [ Parent ]

  •  Hotlisted. Thanks for writing this! eom (0+ / 0-)

    "It's not enough to be right. You still have to use your nice voice." -said by my then six-year-old daughter; "Love binds us all."-willb48

    by be the change you seek on Thu Apr 08, 2010 at 08:37:25 PM PDT

  •  Well, then, there is not a prayer (0+ / 0-)

    that we would considering a move back to the States before 2014... unless Congress pushes up the effective dates of HIR.

    Four more years of insurers doing their best to wring as much blood money from Americans as they possibly can while they can. Very sad.

  •  I didn't know about this! thanks for writing (0+ / 0-)

    up on this. Damn it.

    "About that Hopey Changey Thing --Change takes Courage"

    by We Want Change on Thu Apr 08, 2010 at 08:50:39 PM PDT

  •  You've Been Rescued (1+ / 0-)
    Recommended by:
    B Dizzle

    "What the cynics fail to understand is that the ground has shifted beneath them"

    by ItsJessMe on Thu Apr 08, 2010 at 09:03:48 PM PDT

    •  thanks ItsJessMe! (1+ / 0-)
      Recommended by:
      ItsJessMe

      thanks for the rescue!!

      these days, its hard to find a topic that can still make a kossack say "I didnt know about this!"

      Orville and Wilbur Wright never needed a pilot's license...

      by B Dizzle on Thu Apr 08, 2010 at 09:11:51 PM PDT

      [ Parent ]

Click here for the mobile view of the site