Tuesday, March 23, 2010

Welcome To My (Your) Nightmare - Your Privacy, Gone!

Ladies and gentlemen, there are many reason this so-called "health care reform" was a terrible idea. The plan as offered is not financially sustainable, essentially transfer costs to the shoulders of the young and financially fortunate, withdraws long established protection for our cherished "seasoned citizens" and does many other less savory things, many of which have been discussed ad nauseum.  

Tonight, let me spend a few moments covering some road less traveled, but no less important.

Point:  The government now has the license to rip away much of the people's right to privacy.  Worse than you bedroom, they will now have unfettered access to your doctor's exam table.

Some background:  When a person signs up for an insurance plan at (for example) your place of employment, you fill out an application with some personal information and a lot of fine print.  Within that fine print, there are provisons such as paragraphs on "pre-existing conditions", "prior carrier coverage" and typically a clause that sounds something like this one - from Aetna Insurance (which I just happen to have close at hand):

" I authorize the release of any medical/behavioral treatment, any medication or other information necessary to process a claim from any medical provider(s) who have treated (him/her)."

Please, take a moment and soak in the entire context of this statement.  I believe it to be incredible important.

An insurance carrier normally has a system of checks and balances, both to protect against fraud by covered individuals, but also to track risks from providers. Carriers have department like Risk Management, Utilization Review, Quality Assurance - sometimes with different labels, but similar responsibilities.  When the insurance carrier received a claim from your provider, it is coded with a special health-care specific language called ICD-9 and CPT codes - something of a medical "Dewey Decimal System".  The ICD-9 and CPT Codes tell the insurance company for what condition you were seen, what modalities of therapy you were prescribed, and the treatments actually rendered.

As an example, if you were seen today for flu (not piggy flu):
The ICD-9 code for your diagnosis (Influenza (NOS))  would be 487.1.
The chest X-ray your doctor ordered would be 87.3.
Keflex (an antibiotic) you were given would be coded E930.5.
And the entire visit is documented.  All these codes correspond to rates of payment, agreed upon contractually, and are the basis for which your provider is paid.

Of course if you had, let's say:
Cancer of the lower lung (162.5), or
Sexual impotency due to emotional issues (302.72), or even
Human Immunodeficiency Virus - type2 (079.53); you might be less excited about people knowing.

This information is provided to every payer, for every patient visit for which a claim is submitted.  Claims are typically handled in an automated fashion, and I imagine 90% or more sail through anonymously enough.  That is, unless a "red flag" condition presents itself.  If a condition or therapy of special interest is encountered, a manual review is triggered - something like the IRS system of processing tax returns.  Some examples of these triggers (in no way an exhaustive list) are:

*  A pre-existing condition (since diseases are coded as acute (new onset) or chronic (continuing affliction) this is easy to note - and might could trigger a manual review;
*  Diagnosis of special concern, such as communicable diseases, cancer, HIV, pregnancy, mental conditions and so on;
*  Prescribing non-formulary drugs and interventions (often newer or less traditional therapies)
*  Date of treatment - this is relevant because insurers can limit or deny treatments for certain things (such as a pre-existing condition) for a certain period of time, typically varying from 6-18 months, after they begin covering you.
And other conditions as seen fit by the insurer. No one but their own "insiders" really know exactly what data mining is in effect but every company does profile and check claims with certain flags.  It's the way of things.  I know this because I had been a part of the system for more than 2 decades.  I learned from the insurance companies themselves.

Anyone catching on here?  If not, let me connect the dots...

Generally speaking, government agencies today have access to your medical history under two circumstances - per your specific written request, or per a court order/subpoena.  It is not as easy as you might think - mostly because of the Health Insurance Portability and Accounting Act (known as HIPAA) - for anyone to get into your medical records.  However, with the government heading toward being the single guarantor of last resort (as noted elsewhere, there is a general feeling that insurance companies will begin falling - or ceasing medical coverage - in maybe two years?), the government then also inherits the right to access your medical history - since it is paying the bills.

And if this does come to pass, who will process these claims?  The IRS?  HHS?  A new government medical bureaucracy?  Anyone here want the IRS in your doctors office?  I cannot say with great certainty how that process will come to pass, and don't know anyone who does. But one thing is clear - our government has in its possession a vehicle with which it can begin to strip away most any veil of privacy we have.  If there is one place other than my bedroom I do not want my government, it's in my doctors exam room.

I found no real address of privacy concerns in the 2000+ pages of HR 3200 I searched through on-line.  The concept concerns me, and it should concern you.  If you did not have enough reason to fight for repeal or replacement of this abhorrent measure, perhaps you do know.

And as a treat for you who waded through my dissertation, may I reward you with some Alice Cooper, a great performance with the Muppets (which are somewhat analogous to our current elected representatives).  Enjoy!


  1. One particular insurance company uses this info to insure that you won't make any claims for anything related for the next ten years. Example: Female, back pain. Oh no, that breast reduction is a no for 10 years. That neck pain might be related, so no for 10 years. That growth causing pain on your shoulder is also a no for 10 years and those migraines...no for 10 years.

  2. They use the mined data for many things. More benevolent organizations use data to offer preventive health classes, since the adage "An ounce of prevention is better than a pound of cure" is spot on. Others use it as you state - for less savory purposes.

    But the truth is, if we give Government free access to the most intimate parts of ourselves - our bodies - there is little personal freedom left.

  3. Doesn't GE have a radio ad out about storing your medical records electronically and how great it is! Next will be the RIFD chip ads complete with a GPS tracker.