Insurers shun those taking certain meds

How health insurers secretly blacklist those with certain ailments.

By John Dorschner
The Miami Herald
March 28, 2009
Some insurers will automatically reject applicants who are using certain prescription drugs.
The medications, of course, are indications of specific health problems. To make sure that applicants are not lying, insurers hire a data-gathering service — Medical Information Bureau, Milliman’s Intelliscript or Ingenix Medpoint.
Intelliscript and Medpoint do computerized searches of a person’s drug use, gleaned from pharmacy benefits managers and other databases. The two companies say they comply with privacy laws. “Ingenix requires each Medpoint client to obtain the authorization of the individual applicant or insured person,” said Ingenix spokeswoman Karin Olson.
http://www.miamiherald.com/living/health/costs/story/973158.html

The health care financing systems in other nations are designed to assist patients in paying for their health care. Computerized searches of personal drug use as described in this article is yet one more example of how our private insurance industry adopts policies that are designed to avoid paying for the patients’ health care.
It is no surprise that UnitedHealth’s Ingenix is a player in this scheme to protect the insurers’ finances to the detriment of patients. They recently reached a settlement for cheating patients and physicians through another scheme to underpay for legitimate services, again protecting the insurers finances.
There are two issues here, about which we should all be concerned. First is that this is still another example of health care costs that are wasted on excessive administrative services. It is particularly egregious that these services, for which we are the payers, are detrimental rather than beneficial for the patients. That’s the opposite of what we should expect from our health care financing system.
The second concern is perhaps more ominous. Right now Congress and the administration are pushing the expansion of information technology (IT) systems when it is not at all clear that privacy and confidentiality issues are being adequately addressed. Pharmacy benefit managers (PBMs) are already using IT systems, and look at what is happening. Private insurers are doing computerized searches of your personal drug use gleaned from the PBM databases. Not only are they invading your privacy, but the intent is to defeat the purpose of insurance by denying you coverage.
Intelliscript (Milliman) and Medpoint (Ingenix/UnitedHealth) say that they comply with privacy laws, yet how many people in this gigantic private administrative bureaucracy have access to your personal information? The Fair Credit Reporting Act requires the companies to let you see your personal information if you so request, and how many more administrators are there to peek at your private records as the information is transmitted back to you? Merely passing laws against invasion of medical privacy is not enough. If invading your privacy in an IT system can be done, it will be done.
Isn’t there a theme here? We pay a whole lot of extra money to a private health care financing industry that uses our funds to cheat us out of the health care that we should have. And Congress and the administration are calling for an expansion of this very sick system of financing health care?
Congress should have the common sense, integrity, and decency to jettison the private insurance industry and provide us with our own public health care financing system that would save us money so it could be used where we want it to be used – on our health care. What is so difficult about this concept?

How health insurers secretly blacklist those with certain ailments.

By John Dorschner
The Miami Herald
March 28, 2009

Some insurers will automatically reject applicants who are using certain prescription drugs.

The medications, of course, are indications of specific health problems. To make sure that applicants are not lying, insurers hire a data-gathering service — Medical Information Bureau, Milliman’s Intelliscript or Ingenix Medpoint.

Intelliscript and Medpoint do computerized searches of a person’s drug use, gleaned from pharmacy benefits managers and other databases. The two companies say they comply with privacy laws. “Ingenix requires each Medpoint client to obtain the authorization of the individual applicant or insured person,” said Ingenix spokeswoman Karin Olson.

http://www.miamiherald.com/living/health/costs/story/973158.html

Comment:

By Don McCanne, MD

The health care financing systems in other nations are designed to assist patients in paying for their health care. Computerized searches of personal drug use as described in this article is yet one more example of how our private insurance industry adopts policies that are designed to avoid paying for the patients’ health care.

It is no surprise that UnitedHealth’s Ingenix is a player in this scheme to protect the insurers’ finances to the detriment of patients. They recently reached a settlement for cheating patients and physicians through another scheme to underpay for legitimate services, again protecting the insurers finances.

There are two issues here, about which we should all be concerned. First is that this is still another example of health care costs that are wasted on excessive administrative services. It is particularly egregious that these services, for which we are the payers, are detrimental rather than beneficial for the patients. That’s the opposite of what we should expect from our health care financing system.

The second concern is perhaps more ominous. Right now Congress and the administration are pushing the expansion of information technology (IT) systems when it is not at all clear that privacy and confidentiality issues are being adequately addressed. Pharmacy benefit managers (PBMs) are already using IT systems, and look at what is happening. Private insurers are doing computerized searches of your personal drug use gleaned from the PBM databases. Not only are they invading your privacy, but the intent is to defeat the purpose of insurance by denying you coverage.

Intelliscript (Milliman) and Medpoint (Ingenix/UnitedHealth) say that they comply with privacy laws, yet how many people in this gigantic private administrative bureaucracy have access to your personal information? The Fair Credit Reporting Act requires the companies to let you see your personal information if you so request, and how many more administrators are there to peek at your private records as the information is transmitted back to you? Merely passing laws against invasion of medical privacy is not enough. If invading your privacy in an IT system can be done, it will be done.

Isn’t there a theme here? We pay a whole lot of extra money to a private health care financing industry that uses our funds to cheat us out of the health care that we should have. And Congress and the administration are calling for an expansion of this very sick system of financing health care?

Congress should have the common sense, integrity, and decency to jettison the private insurance industry and provide us with our own public health care financing system that would save us money so it could be used where we want it to be used – on our health care. What is so difficult about this concept?