Pre-Existing Conditions? Exclusions? Rescission? Just as financial companies rely on “credit reports” to establish credit for customers, insurance companies utilize “medical report” files to assess the health, determine the insurability, and set the price for insurance applicants and policyholders. 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.

“How To Request Your Consumer Medical Report Files”

Unfortunately, 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 databases to screen out applicants based on their personal medical conditions, health treatments, family history, drug purchases, and lifestyle choices. “Consumer Reports Health – Denied Insurance Because of an Error in her MIB Report”

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 consumer reports, available from a group of little-known intermediary companies, typically include voluminous information going back five years on dosage, refills, and possible medical conditions. The reports also provide a numerical score predicting what a person may cost an insurer in the future.

typo under ‘tags’

“Ma Baucus”

Baucus is a major-league, large-type dirtbag…

Jason needs to let all the ‘thank you’ folks know about this.

The Democrats like the Republicans are completely in bed with these insurance scumbags, including WellPoint.

They have screwed us. I say we screw them back and vote third party.

I love how the unidentified White House staffer in the Reuters article says they may “even” have to bring in the howitzers: the Presidential bully pulpit.

What a joke.

Seems to me that if they had a regular program of checking medical histories rather than only checking when claims are made…that would be defensible. But, by definition, the Wellpoint means that you will be denied when you need the insurance most and when cancelling you has the most value to them.

I just don’t understand how taking premiums until you have to deliver on your side of the bargain is anything but fraud on the insurance company’s side.

Hi Jon:

I saw this statement in a comment on Jane’s entry on WellPoint’s obnoxiousness:

” … Unfortunately, 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 databases to screen out applicants based on their personal medical conditions, health treatments, family history, drug purchases, and lifestyle choices. “Consumer Reports Health – Denied Insurance Because of an Error in her MIB Report” …”

The comment cited this page.

Is there any information available about what the law that Obama just signed does or does not do with respect to these databases and the health insurance corporations’ use of them? If the law does nothing at all about these databases, then I’d say it is probably a complete scandal due a lot of attention! These databases would appear to be a completely unregulated instrument by which insurance corporations can much more easily target people for plan cancellation or, failing that, pricing schemes that effectively accomplish plan denial, cancellation, or rescission.

Really, I don’t know how anyone could vote for a Democrat or a Republican again, at least not without a very compelling argument in favor of this on a case-by-case basis …

Agreed. Wonder how many times that definition of insanity (doing the same thing over and over, expecting a different result) has been referenced in FDL comments over the past year? The evidence continues to mount that we are not being represented in our so-called representative democracy.

Hamsher had an interesting diary on this issue shortly after the passage of HIPPA – she seems to think that non-participation is a guaranteed way to fail (participation in this case meaning voting, etc.) but that it may be possible that, even formed into a special interest, progressive reform really may face a bleak and limited chance for accomplishing anything at all.

You need to change the election laws for the democracy actually represents the people.

I’ve been tempted right up until election day not to vote and have always caved and pushed that lesser of two evils button. At this moment in time it seems as if voting makes very little difference, at least on a national level. Watching every single last progressive House member fall in line and vote for this POS squoze the very last drop of Yes We Can right out of me.

You’re right. Maybe that’s where we should put our energy. I don’t think I can spend one penny or one minute working for Dems again any time soon, and I think the very best we can hope for out of third parties in the next couple of cycles is to elect a few obstructionists who can keep crap like this healthcare bill from passing. But I don’t see a way forward that gets us any positive change for a long time.

Insurance companies should be addressed and prosecuted for what they are rackets.

Rather than trying to pin the tail on some donkey that might advocate for us I think pressuring them once they are there to launch criminal investigations. These people have proven they have no regard for the law. Passing more laws is fine but it it not the whole solution.

I guess the way I look at it is like this: I am voting for representation. I’ve learned over a long period of time that neither party’s candidates will represent me if they get my vote and my money for their campaign. So if I vote to elect people who are going to walk all over myself, I am just volunteering to be a victim.

It may suck to not have a dog in most races, and to not have a real hope that people like you and I are going to be represented in the political system, and see the sane and positive reforms and changes we all know are needed come to pass. However, what we CAN have is the self-respect that comes from not participating in a gamed electoral system that is set up to exploit and use us, and that perpetuates a really badly dysfunctional status quo.

The health insurance and pharmaceutical companies are best called what they are: cartels.

” … Cartels usually occur in an oligopolistic industry, where there is a small number of sellers and usually involve homogeneous products. Cartel members may agree on such matters as price fixing, total industry output, market shares, allocation of customers, allocation of territories, bid rigging, establishment of common sales agencies, and the division of profits or combination of these. The aim of such collusion (also called the cartel agreement) is to increase individual members’ profits by reducing competition …”

We have to get insurance companies out of the business of healthcare, period. There’s no fine too high for them to pay and perp-walking a few token insurance executives to jail won’t stop them. Just like the banksters, they basically have the keys to the Treasury now and they’re not going to give them up.

The evidence continues to mount that we are not being represented in our so-called representative democracy.

Absolutely, and this HCR debacle is one more piece of evidence that primarying those Dems is but a small, too-little-to-late piece of the solution. We need ballot access rules (such as those taking shape in OH, as ElDuderino reported yesterday) which actually give voice to dissent, and the longer term goal must be an end to representative democracy in favor of direct participation in the proposal, formulation, and enacting of public policy.

I don’t understand why Baucus brags that everyone else is doing his job (Fowler). Baucus was hired to write the laws. Why is he still in office, when is his term up. Why is Blanche Lincoln leading Halter in the polls? What is going on here?

Not only health care. There are a host of pursuits designed to further the public good which should never fall victim to profitability. The tenet that if you can make money off of it you should is largely what got us to this place. It has ruined the global economy, food supply, and our legal system.

“Nobody is going to care about the fine nuances of “senate bill” versus “house bill” or whatever.”

Yglesias

sure Matt, whatev

And yet the rubes can still be persuaded to rally around capitalism and privatization. They don’t give a rat’s ass about the public good until they need their unemployment check or a fire put out.

I agree. Prosecution could be a way to convince everyone even the politicians.

If patients are consumers, they need to be more knowledgeable and demand marketplace transparency! Unfortunately, all insurance companies practices rescission and every applicant consents to an ongoing search of their personal and medical history. (“How To – Check Your Pre-Existing Conditions”)

Just as financial companies rely on “credit reports” to establish credit for customers, insurance companies utilize “medical report” files to assess the health, determine the insurability, and set the price for insurance applicants and policyholders. 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.

In fact, 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 databases to screen out applicants based on their personal medical conditions, health treatments, family history, drug purchases, and lifestyle choices. (“Consumer Reports Health – Denied Insurance Because of an Error in her MIB Report”)

[Mod Note: Please limit linking and championing (aka blog whoring) of other sites to one per day]

“Regulated by the FCRA” simply means that the insurance corporations are legally entitled to do whatever they feel like and that the databases exist to serve them, and that individual people are powerless here. The FCRA is a wish-list created by the financial sector and passed directly into law.

Do you have any information as to what impact the PP/APA have on the use of these databases? If the “health care reform” law does nothing at all with these databases and the use of them besides leave them covered by the FCRA – which, again, was simply an industry wish list – then this is a scandal due a lot of attention.

Joey, I am somewhat new here so please forgive me if you’re a regular and I just don’t recognize you. But if you’re not, and you’re affiliated with the site you keep linking to, you should disclose that. Thank you.

thanks carol! me too! there’s not much information out there beyond wikipedia.

Too few people are aware of these consumer reporting agencies. I’m advising that all insurance consumers understand what they are paying for and how their policy contract operates. This information is free!! (I didn’t recommend the site; just linked to the content)

Yep, that’s it.

Pharmaceutical cartel. I can’t imagine I’ll ever call it anything else.

The FCRA, despite many shortcomings, does provide for some consumer protections with regards to the use of “consumer reports” by companies to make credit decisions.

Under the FCRA, the Medical Information Bureau (MIB), Ingenix Inc, and Milliman Inc are categorized as “nationwide specialty consumer reporting agencies” and must provide annual disclosure of credit reports to all consumers who request their files. (Note, these reporting agencies must respond to all consumer requests for disclosure. So, if you make a request, you’ll get a response, even if to say there is no information for you on file.)

The PP/APA does have some impact on the process of underwriting, with respect to the use of pre-existing conditions. In addition, there is some limit on the use of rescission for fraud by omission. However, I dont think the PP/APA addresses the operation of these companies or regulates their function in the insurance industry.

Forgive me, I’m new and not politically savvy in the least. I’m wondering, though, why is the government getting away with all of the ammendments, or changes, to bills like this? How can they take a bill that was promoted as a way to insure millions of Americans who do not have insurance and turn it into a new way to screw the American people? Is there anything that can be done besides waiting for the next election, voting differently, and praying that person isn’t lying too?

It’s been my term for a while … I think of it as a single syllable of pure liquid truth that rolls right off the tongue!

All the insurance companies have to do is add still more questions and demand insane levels of detail, and every applicant who has had less than 100% perfect Superman health can and will be found guilty of ‘fraud’ or ‘intentional misrepresentation’. Who will remember every injury, every illness, every single doctor visit?

“Forgot to put down that broken nose at age six? Too bad — rescinded. Retroactively.”

Stick around here for a while ;)

great observation Becca! Maybe an applicant doesn’t even have to misrepresent, but just be in the wrong family tree!

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.”

From the Daily Kos diary – “What Conditions can Pre-Exist? Rejected for Womanhood, Homosexuality and Dangerous Lifestyles.”

Cartels too. As in drug cartels. But they are also rackets without the competition from other gangs.

I think you have a point there. Cartels are cartels internally, in that they control markets within their territory. But, at least with our drug cartels, they also struggle for dominance with one another, and if any shows a sign of weakness, stupidity or insanity, it can flare up into wholesale war. (Witness Mexico for example).

I think of the insurance companies more like a Mafia Syndicate/Commission. They hashed out their battles long ago, and the only people they fight (and kill) now are their customers.

And given the fact the insurance companies have access to this Medical Information Bureau, it only serves as proof that the ridiculous medical history questionnaires they make applicants fill out are an utter sham, existing solely for the purpose of trying to get people to pre-disqualify themselves.

Sure, some of it’s for pre-screening purposes, so they can immediately reject the ones who check the box, “Why yes, I -do- have cancer.” But I believe more commonly they just want any discrepancy possible, so that if you do get cancer while covered, they can pull out the paperwork and crow, “Look! You didn’t report going to the doctor for strep throat in 1989!”

I mean, really — when I apply for a loan or credit card, all I have to do is give my name and SSN and they run a credit check. They don’t make me write down every loan and card I’ve ever had in the past, and recount everything I ever charged or bought… Because, seriously, if I nearly went broke buying Beanie Babies on eBay ten years ago, doesn’t that mean I have a pre-existing financial disorder (not to mention highly questionable sanity)?

This is one of the reasons I stopped coming to FDL.

Because while, yes, the Senate bill does not have an independent review capability, THE RECONCILIATION BILL DOES.

These two sections were added to the Patient Protection and Affordable Care Act via the Health Care and Education Reconciliation Act of 2010:

‘(f) Rescission- A health insurance issuer may rescind health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2). The Secretary, no later than July 1, 2010, shall issue guidance implementing this requirement, including procedures for independent, external third party review.’.

and:

‘SEC. 2746. OPPORTUNITY FOR INDEPENDENT, EXTERNAL THIRD PARTY REVIEW IN CASES OF RESCISSION.

‘(a) Notice and Review Right- If a health insurance issuer determines to rescind health insurance coverage for an individual in the individual market, before such rescission may take effect the issuer shall provide the individual with notice of such proposed rescission and an opportunity for a review of such determination by an independent, external third party under procedures specified by the Secretary under section 2742(f).

‘(b) Independent Determination- If the individual requests such review by an independent, external third party of a rescission of health insurance coverage, the coverage shall remain in effect until such third party determines that the coverage may be rescinded under the guidance issued by the Secretary under section 2742(f).’.

So there ya have it.

Here is the link to the complete reconciliation bill text:

http://www.opencongress.org/bill/111-h4872/text

That’s just sad.

Since all reconciliation bills have to originate in the House, they used the original House version of the health care bill, then gutted it and replaced it with the Senate language.

There is no “section 2756″ in the final bill signed by the President.

The same type of lobbying these companies have been doing at the Federal level they’ve been doing for decades at the state level. That’s why the health insurance system we have is so screwed up and theses companies can literally get away with murder.

They ‘lobby’ state legislators to get favorable rule and reg passed which help them a) eliminate competition b) get the rates and profit margins they want.

I do not understand why when the government is the problem the solution is more government. More government is just more people to ‘lobby’ to get what you want.

If these companies were not protected by state governments from having to compete with more reputable companies, they would long ago have been out of business.

Free market my @ss. Health insurance is a (state) governemnt protection racket (soon to be a Fed gove protection racket) that is worthy of RICO prosecution.