People desire to keep their medical and health care records private for many reasons, including personal privacy, avoiding stigmas associated with certain diseases or conditions, and preventing job and economic discrimination. Because patients are treated as consumers, everyone that pays for insurance should verify their individual medical report disclosure files.
An untold number of people routinely rejected for health, life, and disability insurance for reasons they never could have guessed: Insurance companies are using massive, commercially available prescription databases to screen out applicants based on their personal information, family histories, and lifestyle activities.
Based on results from the "must read" dKos Rescued Diary, "How To - Check Your Pre-Existing Conditions," few people are aware that insurers use detailed "medical reports" and that pre-existing conditions can be triggered by MEDICAL AND NON-MEDICAL information.
"Being a woman is no longer a pre-existing condition." That’s the new mantra, repeated triumphantly by House Speaker Nancy Pelosi, Senator Barbara A. Mikulski and other advocates for women’s health. But did you ever wonder how exactly womanhood is a pre-existing condition?
Until 2014, it is perfectly legal in most states for companies selling individual health policies — for people who do not have group coverage through employers — to engage in "gender rating," that is, charging women more than men for the same coverage, even for policies that do not include maternity care. (Insurers have also applied gender-rating to group coverage, but laws against sex discrimination in the workplace prevent employers from passing along the higher costs to their employees based on sex.)
In short, the personal health and life insurance market depends heavily on technology to collect underwriting information, expedite policy coverage, and reduce fraudulent pay-out costs. And, just like financial companies rely on the consumer reporting bureaus Experian, Equifax, and TransUnion to validate your credit, all major insurers depend on "medical reports" from a group of little-known corporations, known as nationwide specialty consumer reporting agencies, to assess the health, determine the insurability, and set the price for insurance applicants and policyholders.
If you have never heard of the Medical Information Bureau Inc., Ingenix Inc., and Milliman Inc., your insurer has! According to a press release from the powerful health lobbying group America's Health Insurance Plans (AHIP),
"The Medical Information Bureau Inc. (MIB) is a cooperative data exchange formed by the North American insurance industry more than 100 years ago. Today, the MIB 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."
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.
Indeed, 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’ prescription histories. These online reports, available to insurers in seconds from little-known intermediary companies, typically include voluminous information going back 5 to 7 years. The reports also provide a numerical score predicting what a person may cost an insurer in the future. The Washington Post says these database records, which "are like credit reports for your health," have been created for more than 200 million Americans.
Here is where it gets more intricate... while your credit report includes only 'financial-related' information, your medical report file includes medical and non-medical information. In fact, your medical report file may actually include your credit report file! It's all there in The Federal Trade Commission's warning,
"The Medical Information Bureau Inc. (MIB), an organization with approximately 750 member insurance companies, 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." (FTC.gov Press Release, June 1995, "Nation’s Largest Insurance Reporting Agency Agrees To Expand Consumer Rights- Fair Credit Reporting Act requirements to apply to insurance investigations under new policy accepted by Medical Information Bureau Inc. (MIB)")
Functionally, 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 example, researchers found that MIB had five codes for AIDS. All consumers should be aware - not all of the codes at the Medical Information Bureau Inc. are medical. For example,
"MIB has codes that indicate a dangerous lifestyle, including, "adverse driving records, hazardous sports, aviation activity, international travel, and homosexual lifestyle." In the past, says Privacy Journal publishers Robert Smith, MIB had codes that stood for "race," "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."
Additionally, family history and genetic history are two factors, among many, tracked by the Medical Information Bureau Inc. Even if you've never reported this prior history, it can still be connected with you (and your parents, siblings, and off-spring).
"For example, a lawyer named Theresa Morelli applied for individual disability insurance, consented to release of her medical records through the MIB, and was approved for coverage. One month later, her coverage was cancelled and premiums refunded when the insurer learned her father had Huntington’s disease, a hereditary illness. Startlingly, the MIB used applicant’s broad consent to query her father’s physician, a doctor with whom she had no prior patient relationship. More importantly, the applicant herself wasn’t affirmatively diagnosed with Huntington’s carrier status, but suffered exclusion on the basis of a genetic predisposition in her family." (Excerpted from, Theresa E. Morelli, Genetic Discrimination by Insurers: Legal Protections Needed from Abuse of Biotechnology, 9 HEALTHSPAN 8, 8-10 (1992)).
One of the benefits of the new Patient Protection and Affordable Care Act will be to ban the denial of health coverage to women who have had a prior Caesarean section or been victims of domestic violence. (Some companies providing individual policies have refused coverage in those circumstances, regarding Caesareans or beatings as pre-existing conditions that were likely to be predictors of higher expenses in the future.) However, the law's protections against pre-existing conditions for women and children do not go into 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. (For example, "Denied Insurance Because of a Medical Coding Error in Her MIB Report").
PS- Thanks again to the Daily Kos community! Yesterday's dairy "How To - Check Your Pre-Existing Conditions" was called a "must read" by the Diary Rescuers and has now been named a "high impact diary" for April 8, 2010!
"How To - Check Your Pre-Existing Conditions