Nation enters the age of electronic medical records

Clark Howard was talking about an article he had read in The Washington Post stating that health “credit reports” have been compiled on 200 million Americans. Ingenix and Milliman are 2 companies that make billions of dollars developing profiles based on your prescriptions. A “pharmacy risk score” tells insurers the risk level you pose to them as a potential customer.

Pharmacy benefits managers (PBMs) actually sell your information regarding prescriptions. PBMs are a popular option at companies because they offer cheaper prices when you get your drugs online or through the mail — instead of at a retail pharmacy.

The info in your health “credit report” can be used by an insurer to charge you more or decline you coverage altogether.

So how does this play out with HIPAA? Well, The Washington Post reports the following: “Ingenix and Milliman officials stress that they provide data only with the patient’s consent, as required by the Health Insurance Portability and Accountability Act (HIPAA)…But HIPAA does not give the Department of Health and Human Services the ability to directly investigate or hold accountable entities, such as [PBMs] or companies such as Ingenix and Milliman, who are not covered by HIPAA.” See the original report.

Another wrinkle in the story comes with “off-label” prescriptions. Off-label refers to using a prescription for an unintended use. For example, your doctor may be using a depression medication to treat your stomachache. But that off-label usage could redline you with insurers who don’t want to see a history of depression medication — even though you’re not depressed.

Under new federal rules, you are allowed to see your health “credit report” from Ingenix and Milliman.

Clark believes the real problem is not the lack of privacy, but rather the way that insurers are allowed to redline you. We need insurance coverage based on community-rating standards — that is to say, age and sex.

Bookmark and Share