Medical Identity Theft of Health Records Is a Big Problem

Identity theft of health records (commonly referred to as “medical identity theft”) has become big business and a growing problem. Reports of health-record identity thefts jumped 61.5 percent in 2012, federal statistics show. Nationwide, 64,150 data breaches have occurred since October 2009, including 24,429 in 2012 alone, according to the Office for Civil Rights, part of the U.S. Department of Health and Human Services.

Privacy Identity Theft

In a report published in December 2012, the Ponemon Institute, a privacy research firm based in Traverse City, Mich., and ID Experts, data breach consultants in Portland, Ore., estimates that identity theft of health records cost the United States more than $40 billion in 2012, affecting 1.85 million people.

The toll on individuals is high. According to the federal Bureau of Justice Statistics, U.S. households lost about $13.3 billion because of all kinds of identity theft, including health records, in 2010, the latest statistics available. The average loss per household was about $2,200. Of the 1.8 million complaints to the Federal Trade Commission in 2011, 15 percent involved identity theft of all types.

‘Threat is constantly there’

Identity theft of medical records can be especially pernicious. In most cases, thieves use the health data to make financial mischief. More troubling are cases of people being charged for procedures and tests they did not receive and having their medical files filled with the thief’s medical history.

This so-called “medical identity theft” made up 1 percent of all identity theft complaints to the FTC in 2011. But Pam Dixon, executive director of the World Privacy Forum, a nonprofit research group in San Diego, said this is the No. 1 issue the World Privacy Forum deals with, generating hundreds of calls each year from people whose medical files have been corrupted by thieves’ medical information.

“It has led to so much harm,” she said. “Even when there is no [medical] mistreatment, it has caused countless hours of people trying to remove incorrect information from their file. There are serious legal hurdles in removing information from your file even when it’s fraudulent.” That’s because once a medical file includes another person’s medical history, some hospitals argue it can’t be turned over without consent of the impostor.

Larry Ponemon, chairman of the Ponemon Institute, said he expected the number of identity thefts from health care providers to keep rising.

“Things will get worse before they get better,” he said. “We see hacking as a daily event. It just seems that the ability to protect this information is not easy.” As the protections become more sophisticated, “the hackers get smarter,” he said.

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CVS Caremark To Penalize Employees Who Don’t Disclose Weight, Body Fat in Wellness Review

CVS Caremark Corporation has come under fire for asking employees covered under the company’s health care plan to disclose a range of personal information in a “wellness review” — from their weight to blood pressure — or face a financial penalty.  According to company statements, CVS is giving its 200,000 employees an ultimatum: submit your height, weight, body fat percentage (Body Mass Index, aka “BMI”), blood pressure, glucose levels, and other health indicators or suffer an on-going financial penalty of $50 per month.

Not only is CVS Caremark demanding that workers get “wellness reviews” under threat of financial penalty, CVS is also asking workers to give permission to the insurer to turn over that information to a firm that provides benefits support to CVS, the Boston Herald reports. CVS says it will pay for the weight, body fat and blood screenings. But in exchange, workers must sign a form saying the screening is voluntary, and that the insurer can give test results to WebMD Health Services Group (the firm provides health management programs and benefit support to CVS).

An internal CVS document leaked to the press warns that, “[Our CVS Caremark] Colleagues who take action to stay healthy or improve their health, and get results, will be rewarded. Those [CVS Caremark colleagues] who don’t take accountability will have to pay more in the future.” And although the CVS says the medical exams are completely voluntary, anyone who chooses not to weigh in will end up paying an extra $50 per month, or $600 a year more for benefits. And CVS employees don’t have a lot of time to decide what they’ll do; their screening results are due by May 1, 2013.

However, CVS Caremark is far from the only private or public employer one pushing workers to reveal detailed medical information. As health care costs tick up and employers rush to comply with new requirements tied to President Obama’s Affordable Care Act, many companies are asking their workers (and in some cases, workers’ spouses) to undergo rigorous health care screenings aimed at encouraging healthier living — and boosting the company’s bottom line.

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“It Pays to Check Your Credit Report” Says FTC’s Bureau of Consumer Protection

You should really check your credit reports at least once a year. If you’re still not convinced, you should review the results of the Federal Trade Commission’s (FTC) latest study, which shows just how error-prone and inaccurate the credit report files from Experian, Equifax, and TransUnion can be.

The FTC looked at credit reports for 1,001 U.S. consumers and found that one-in-four (26%) people identified at least one material error among their credit reports from the three bureaus. These errors were not minor, but “material” in that the FTC says these alleged errors are in regard to information used to generate credit scores, including the number of collections accounts, the number of inquiries on a credit file, the number late or missed payments, among others. In other words, errors that will only cost you more money for the use of credit.

The FTC report is the first major study that looks at all the primary groups that participate in the credit reporting and scoring process: consumers; lenders/data furnishers (which include creditors, lenders, debt collection agencies, and the court system); the Fair Isaac Corporation, which develops FICO credit scores; and the national credit reporting agencies (CRAs).

Overall, the study found that around 5% of consumers saw corrections to their credit reports that resulted in a credit score swing of at least 25 points, putting them into a better credit risk tier and making them more attractive to lenders.

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Blue Shield of California to Pay $2 Million Legal Settlement for Illegal Policy Rescissions

California health insurance provider, Blue Shield, a San Francisco-based not-for-profit company, agreed to pay $2 million to the City of Los Angeles to resolve accusations that the insurance company improperly dropped policyholders after they got sick and needed expensive treatment. The settlement ends an investigation into more than 1,000 so-called rescissions by Blue Shield.

According to evidence presented in court filings, Blue Shield improperly dropped policyholders and paying customers without regard for whether their customers intended to deceive them about preexisting conditions. The practice resulted in some people losing coverage through no fault of their own, often over trivial bits of health history that had nothing to do with the claims that triggered the investigations.

President Obama made rescission a central theme in his push for a healthcare overhaul. In September 2010, a ban on rescissions for unintentional application errors became one of the first pieces of the healthcare law to take effect.

Blue Shield, in earlier agreements with state regulators, pledged to pay $3 million and to offer new coverage to hundreds of former policyholders. In recent years, Blue Shield is among a handful of California insurers that have paid millions to state and local regulators in response to investigations into the systematic dropping of policyholders with expensive medical needs.

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Medical Identity Theft a Growing Problem in US; Fastest-Growing Segment of Identity Theft

Medical identity theft has claimed 1.5 million victims in the United States, according to the PwC’s Health Research Institute in its research study, “Old Data Learns New Tricks”.  In fact, medical identity theft is the fastest growing segment of identity theft in America, says Jim Koenig, director and leader of PwC’s identity theft practice.

Phil Blank, a senior analyst with Javelin Strategy and Research, which examines incidents of fraud and helps clients respond to them, said 8% of data breach victims in the U.S. had their medical information stolen in 2010. Medical records were the fifth most commonly stolen data. The most common was credit-card numbers. Blank cited the slow economy and more people losing insurance as drivers behind increasing medical identity theft.

Pam Dixon, founder of the World Privacy Forum, said in a 2006 report that “medical identity theft may also harm its victims by creating false entries in their health records at hospitals, doctors’ offices, pharmacies and insurance companies.”  She said the changes to the records could remain in the files for many years. “Victims of medical identity theft may receive the wrong medical treatment, find their health insurance exhausted, and could become uninsurable for both life and health insurance coverage,” Dixon said in the report.

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Consumers Digest – Prescription for Health Insurance Woes

By now, everyone is aware that there are three credit bureaus that sell your credit reports to companies that want to know how you handle your money.

However, according to a report by Consumers Digest in “Prescription for Health-Insurance Woes“, most consumers have no idea that there are also three health insurance bureaus, the Medical Information Bureau (MIB Group), Ingenix Inc. and Milliman Inc., that report on your health to insurance companies, which can then use the information to hike your premiums or deny you coverage.

In fact, the article reveals that each of these three insurance reporting agencies has different policies for collecting and storing information, and they hang on to it for 5 to 7 years, depending on the policy of the agency. Consumers Digest advises that you can try to combat premium hikes and coverage refusals, and perhaps reduce your costs, by checking your health report for errors. Insurance sales agents tell us that they have succeeded in reversing denials of coverage that resulted from errors or outdated information.

If you are applying for a new health insurance plan, you should curtail or postpone your use of nonessential prescription medication and medical procedures until you are accepted, advises Alex Maybaum of AnnualMedicalReport.com, which is an organization that seeks to improve privacy protections for personal medical information. That likely will help you to reduce your insurance costs, he says, because excessive use of nonessential prescription medications drives up the cost of policies.

“Underwriters also don’t like to see unfinished business on the applicant’s records,” warns Jan B. Sherman of BenefitsTamer.com, which provides advice on health-insurance benefits. So ask your doctor whether not-completed procedures are necessary and to note that in your medical records.

Read the full article, “Prescription (Rx) for Health-Insurance Woes” published by Consumers Digest in March 2011 at ConsumersDigest.com.

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One Year Anniversary of The Signing of The Affordable Care and Patient Protection Act

One year ago this week, on March 23, 2010, President Barack H. Obama signed the Patient Protection and Affordable Care Act into law. The one year anniversary will be marked by a series of events from proponents and opponents of the law who are still waging a pitched battle over provisions of the health care legislation.

Administration officials and progressive groups are scheduling more than 100 events across the country this week to sing the praises of the health care law, as Republicans continue to attack its provisions.

Among the prominent Democrats promoting the law this week are Kathleen Sebelius, Secretary of The Department of Health and Human Services (HHS); Tom Vilsack, Secretary of The Department of Agriculture (USDA); Hilda Solis, Secretary of The Department of Labor (DOL); Karen Mills, Administrator of The Small Business Administration (SBA), and Dr. Regina Benjamin, the Surgeon General (OSG), according to news reports and official schedules. Senator Harry Reid, the Democratic Majority Leader, has a small business event on health care planned in his state of Nevada, too.

Health Care for America Now, a coalition of advocacy groups, is sponsoring 75 events in 27 states this week. The coalition of advocacy groups has set a theme for each day: Monday: Protecting Small Business’s Care; Tuesday: Protecting Seniors’ Care; Wednesday: Protecting Patients’ Rights; Thursday: Protecting Women’s Care; and Friday: Protecting Young Adults’ Care. (more…)

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Uncertainty in Health Care Reform Law Causes Worry About Care Limits

In February 2011, a federal judge ruled that Congress violated the Constitution by requiring Americans to buy insurance as part of the health overhaul passed last year, and said the entire law “must be declared void.” With his ruling, U.S. District Judge Roger Vinson set up a clash over whether the Obama administration still has the authority to carry out the law designed to expand insurance to 32 million Americans.

An attorney for the plaintiffs said the ruling meant the 26 states challenging the law must halt implementation of pieces that apply to states and certain small businesses represented by plaintiffs. But the Obama administration said it has no to plans to halt implementation of the law. Already, it has mailed rebate checks to seniors with high prescription drug costs, helped set up insurance pools for people with pre-existing medical conditions and required insurers to allow children to stay on their parents’ insurance policies until they reach age 26.

“We will continue to operate as we have previously,” a senior administration official said.

Meanwhile, faced with the uncertainty of the implementation of the law, patients around the country are growing anxious and worried about what the court’s ruling, and the politics of Washington, will mean for their own healthcare and insurance policies. For example, Hillary St. Pierre, a 28-year-old former registered nurse who has Hodgkin’s lymphoma, had expected to reach her insurance plan’s $2 million limit this year. Under the new law, the cap was eliminated when the policy she gets through her husband’s employer was renewed this year.

Ms. St. Pierre, who has already come close once before to losing her coverage because she had reached the plan’s maximum, says she does not know what she will do if the cap is reinstated. “I will be forced to stop treatment or to alter my treatment,” Ms. St. Pierre, who lives in Charlestown, N.H., with her husband and son, said in an e-mail.
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Inside Deloitte’s New Life Insurance Consumer Assessment Technology and Predictive Modeling Software

The use of sensitive personal information by insurance companies to execute underwriting decisions is expanding to include consumer marketing data. An investigation by The Wall Street Journal revealed a remarkable proliferation of the use of consumer-marketing data to create a “predictive modeling” system for insurance applicants.

With an inside view of Deloitte Consulting LLP’s new consumer assessment technology for life insurance companies, the Wall Street Journal reports that Deloitte designed predictive modeling software that uses data such as personal and family medical histories, as detailed on written insurance application forms, to categorize people into various risk categories.

Deloitte’s software also has access to industry-shared information from past insurance applications and motor-vehicle reports. Furthermore, the Deloitte software also uses consumer-level marketing data from Equifax Inc.’s marketing-services unit, since acquired by Alliance Data Systems Corp. The consumer files contained hundreds of data points on each person catalogued, including attributes applied to each individual, such as hobbies, TV-viewing habits, and income estimates. In Deloitte’s final predictive model, the nontraditional consumer-marketing data represented about 37% of the predictive ability, it says.

Life insurance provider Aviva and Deloitte judged the test largely successful. “The use of third-party data was persuasive across the board in all cases,” said John Currier, chief actuary for Aviva USA. (more…)

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Insurance Companies are Mining Online Data To Predict Medical Health and Lifespan

Life insurers are testing new ways to predict life expectancy and are mining personal data online and offline to analyze the health and medical conditions of consumers. According to an investigation by the Wall Street Journal, executives at American International Group Inc., Aviva USA, and Prudential Financial Inc., confirm they are exploring the use of consumer-marketing data to create a “predictive modeling” system for insurance applicants.

Making the approach feasible is a trove of new information held by giant U.S. data-collection firms, such as Acxiom, Alliance Data Systems Corp., Experian PLC, and Infogroup, who each have detailed information on more than 100 million American households. Deloitte Consulting LLP, a major backer of the concept, has pitched it in recent months to numerous insurers.

These data-gathering companies have such extensive files on most U.S. consumers – online shopping details, catalog purchases, magazine subscriptions, leisure activities and information from social-networking sites – that some insurers are exploring whether data can reveal nearly as much about a person as a lab analysis of their bodily fluids.

This data increasingly is gathered online, often with consumers only vaguely aware that separate bits of information about them are being collected and collated in ways that can be surprisingly revealing. In this Wall Street Journal NewsHub video interview, reporter Leslie Scism explains how “Insurers Test Data Profiles to Identify Risk Clients”.

Although the personal information sold by marketing-database firms is lightly regulated, utilizing it in the life insurance application process would “raise questions” about whether the data would be subject to the federal Fair Credit Reporting Act, says Rebecca Kuehn of the Federal Trade Commission’s division of privacy and identity protection.

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Insurers Test Personal Data Files to Identify Risky Applicants

Life insurers are testing an intensely personal new use for the vast dossiers of data being amassed about Americans: predicting people’s longevity. The article “Insurers Test Data Profiles to Identify Risky Clients”, by The Wall Street Journal reveals a remarkable proliferation of the use of consumer-marketing data to create a “predictive modeling” system for insurance applicants.

Insurers have long used blood and urine tests to assess people’s health—a costly process. Today, however, data-gathering companies have such extensive files on most U.S. consumers—online shopping details, catalog purchases, magazine subscriptions, leisure activities and information from social-networking sites—that some insurers are exploring whether data can reveal nearly as much about a person as a lab analysis of their bodily fluids.

Making the approach feasible is a trove of new information being assembled by giant data-collection firms. These companies sort details of online and offline purchases to help categorize people as runners or hikers, dieters or couch potatoes. They scoop up public records such as hunting permits, boat registrations and property transfers. They run surveys designed to coax people to describe their lifestyles and health conditions.

Increasingly, some gather online information, including from social-networking sites. Acxiom Corp., one of the biggest data firms, says it acquires a limited amount of “public” information from social-networking sites, helping “our clients to identify active social-media users, their favorite networks, how socially active they are versus the norm, and on what kind of fan pages they participate.”

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Congress Reveals the Largest Insurance Companies are Using Pre-Existing Conditions to Deny Coverage

The U.S. House of Representatives, Committee on Energy and Commerce conducted an investigation into the extent of coverage denials and exclusions for pre-existing conditions in the individual health insurance market.

In the following memorandum, Congress reveals that the (1) the four largest for-profit health insurance companies, Aetna, Humana, UnitedHealth Group, and WellPoint, denied over 600,000 individuals coverage because of pre-existing conditions in the three years before passage of health reform and (2) the number of coverage denials increased significantly each year.

Shockingly, the Committee on Energy and Commerce uncovered that Aetna, Humana, UnitedHealth Group, and WellPoint refused to pay 212,800 claims for medical treatment due to pre-existing conditions between 2007 – 2009. In some cases, the companies offered health insurance to individuals with pre-existing conditions, but used medical riders to exclude coverage or increase deductibles for the pre-existing conditions.

American consumers were aghast to learn that Aetna, Humana, UnitedHealth Group, and WellPoint all had corporate business plans for increasing revenue by relying pre-existing conditions to limit the amount of money paid for medical claims. In one document, executives devised a plan for “strategic growth” in the individual market that identified areas of opportunity to be “improved pre-existing exclusion processes, tighter condition and large claim review, [and] tighter underwriting guidelines.”

Congress also exposed other internal corporate documents showing that insurance company executives were considering practices such as lengthening the look-back period, assessing separate deductibles specifically for identified pre-existing conditions, denying payments for prescription drugs related to pre-existing conditions, linking additional claims to pre-existing conditions exclusions, and narrowing the definition of prior creditable insurance coverage.

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Baby Denied Healthcare While in the Womb. Aetna Says Newborn has Pre-Existing Condition.

Health insurance company Aetna, held up paying thousands of dollars in medical charges to newborn Kinsleigh Barnes, according to a report by ABC News. The reason? The insurance company said the newborn might have been suffering from a pre-existing condition.

New mother Kelly Barnes is heartbroken and angry. Barnes said she called Aetna hoping for a resolution.  “It’s like you’re talking to somebody who is reading from a script,” Barnes said. “They don’t have answers for you based on what you’re telling them.”

According to Barnes’ attorney, “Under Aetna’s own definition, in order to deny for pre-existing condition, there has to be medical advice or care that was rendered or given. And in this case, of course, that would be real hard, given the fact the baby was still in the womb.”

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U.S. to Let Insurers Raise Fees for Sick Children

The Obama administration, aiming to encourage health insurance companies to offer child-only policies, said that health insurance companies could charge higher premiums for coverage of children with serious medical problems, if state law allowed it.

Earlier this year, major insurers, faced with an unprofitable business, stopped issuing new child-only policies. They said that the Obama administration’s interpretation of the new health care law would allow families to buy such coverage at the last minute, when children became ill and were headed to the hospital.

The difficulty in preserving access to child-only insurance policies is the latest example of unintended consequences of the new law, the Patient Protection and Affordable Care Act. The problem may be solved in 2014. If Democrats can beat back Republican efforts to dismantle the law, most Americans will be required to carry health insurance, starting in 2014, and insurers will be required to accept all applicants, regardless of pre-existing conditions.

The new policy statement, issued Wednesday by Kathleen Sebelius, the secretary of health and human services, came with a fresh blast of criticism of the insurance industry.

“Unfortunately,” Ms. Sebelius said, “some insurers have decided to stop writing new business in the child-only insurance market, reneging on a previous commitment made in a March letter to ‘make pre-existing condition exclusions a thing of the past.”

The White House has been tussling with insurers for months, trying to get them to provide coverage for children with cancer, autism, heart defects and other conditions. In a letter Wednesday to the National Association of Insurance Commissioners, Ms. Sebelius said the decision of some insurers to stop issuing child-only policies was “extremely disappointing.”

On March 29, 2010 six days after President Obama signed the health care bill, Ms. Sebelius sent a sternly worded letter to insurers, saying, “Children with pre-existing conditions may not be denied access to their parents’ health insurance plan.”

Karen M. Ignagni, president of America’s Health Insurance Plans (AHIP), a trade group, sent an immediate response, accepting the administration’s demand. Robert E. Zirkelbach, a spokesman for the AHIP trade group, said Wednesday, “Health plans have upheld the commitment” by Ms. Ignagni. “Children with pre-existing conditions are able to obtain coverage on their parents’ policies,” he said. (more…)

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500,000 Americans Denied Health Insurance Coverage Based on Pre-Existing Conditions

The four largest health insurance companies in the United States denied insurance coverage to more than half a million individuals because of their pre-existing conditions from 2007 to 2009, according to an investigation by the House of Representatives Committee on Energy and Commerce. On average, the four companies – Aetna, Humana, UnitedHealth Group and WellPoint – denied 1 out of 7 applicants’ coverage based on conditions such as pregnancy, angina, diabetes and heart disease.

A memo circulated by one unidentified company in 2006 listed 14 medical categories that did not require review, including: any woman who was pregnant or had been treated for infertility within five years.

The congressional investigation found that the number of people who were denied coverage increased about 49 per cent from 2007 to 2009. In a two year period, the insurance corporations refused to pay 212,800 claims for individuals who were already insured based on their previous medical conditions.

The congressional probe also found that each company saw its policy on pre-existing conditions as a key area of revenue growth. For example, internal documents by a company that was not identified by the committee showed that executives were considering practices such as denying payments for drugs related to pre-existing conditions and linking additional claims to pre-existing condition exclusions as ways to limit the amount of money the company had to pay for claims.

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Consumers Protect Privacy Across Multiple Areas with Unified SafetyPlan Service

Increasingly, the everyday activities of consumers are being recorded, measured, and leveraged by businesses for transactional advantages. On an average day, a consumer may unknowingly reveal thousands of data points through financial services, online interactions, communications channels, utilization of modern health care options, and personal activities. Consumers are rarely given the ability to “opt-out” of such tracking and, where such control does exist, the process remains concealed, tedious, and potentially ineffective.

For example, the social networking utility website Facebook.com suffered criticism in May 2010 over its failure to provide individual users with simple privacy tools, prompting founder Mark Zuckerberg to admit the settings had “gotten complex” for users. Thereafter, the company was forced to redesign its privacy controls, announcing to consumers, “social network Facebook has said it will offer a one-stop shop for privacy settings in response to user concerns. The new system will offer users one privacy page with a list of all their applications and a choice of three settings for each.” Zuckerberg also said, “We don’t sell your information and we have no plans to.” Accordingly, many consumers took action to restrict their information and protect their Facebook privacy status.

Yet, in October 2010, consumers were shocked by the Wall Street Journal headline, “Facebook in Privacy Breach; Top-Ranked Applications Transmit Personal ID’s.” The WSJ investigation revealed that many of the most popular applications, or “apps,” on the social-networking site Facebook Inc. were transmitting identifying information. Facebook Inc. was, in effect, providing access to people’s names and, in some cases, their friends’ names, to dozens of advertising and Internet tracking companies.  As the Wall Street Journal specified, “the issue affects tens of millions of Facebook app users, including people who set their profiles to Facebook’s strictest privacy settings. The practice breaks Facebook’s rules, and renews questions about its ability to keep identifiable information about its users’ activities secure.”

A follow-up article by the Wall Street Journal in October 2010, “Facebook Inc. Says User Data Sold To Broker“, revealed that sales of personal user data by Facebook Inc. undermined Zuckerberg’s credibility among users. As demonstrated, even the most vigilant consumers who took action to secure their Facebook profile privacy status were vulnerable to data leakage and exploitation. To help consumers manage these responsibilities, SafetyPlan offers an online service that tracks privacy across six domains – health, online, credit and banking, your devices, your physical property, and in your community – and enables consumers to manage risk. (more…)

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Health Insurance Reform At a Glance – Insurance Market Reforms that Protect Consumers

The recently enacted Federal Health Care law, The Patient Protection and Affordable Care Act, is designed to improve the health insurance marketplace by strengthening consumer protections and providing consumers with the information they need to choose the best health care coverage for their families.

The following list of consumer protections is prepared by the United States House Committees on Ways and Means, Energy and Commerce, and Education and Labor.

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Hospitals Perform “Wallet Biopsy” on Patient Credit Scores Before Providing Treatment

According to BusinessWeek, hospitals and medical care providers are buying credit scores and other financial data about patients to determine if the sick can afford treatment.  In the hospital business they call it a “wallet biopsy.” A growing number of medical centers are using sophisticated software that digs into patients’ finances to help determine whether they will receive free or discounted care.

The procedure, which is not understood by most patients or even many doctors, generally doesn’t come into play when there is an emergency. But it has raised eyebrows for several reasons: Hospital administrators are looking at patient data—credit scores, credit-card limits, and 401(k) balances—not usually associated with treatment decisions.

Evelyn Leonard, a 49-year-old cafeteria worker, says that Halifax Health Medical Center of Daytona Beach, Florida refused to schedule her for radiation treatment earlier this year after staff members questioned her about possibly tapping her 401(k) account to help pay the bill.  Leonard’s annual income of about $18,000 qualifies her for charity treatment at Halifax, and the hospital gave her a 50% discount for a procedure last year related to a benign tumor behind her left eye. She estimates she still owes several thousand dollars to Halifax.

Patients are surprised to learn that they’re being subjected to the analysis, especially so in the case of nonprofit hospitals that historically have been magnanimous with charity care. And some health experts fear that hospitals will use techniques borrowed from the mortgage and car-loan industries to deny treatment to consumers with little or no health insurance.

The surest sign that wallet biopsies are catching on is the proliferation of analysis companies offering their services to the country’s 5,000 hospitals. SearchAmerica, a company that sells patient-analysis software, says that it has 1,000 hospital clients. The three major credit bureaus—TransUnion, Equifax (EFX), and Experian (EXPGY)—are marketing their own customized software for medical providers. And this summer, private equity giant Bain Capital invested $50 million in MedeFinance in Emeryville, Calif. (more…)

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MainStreet.com – Little Reasons for Big Insurance Hikes

A report by MainStreet.com, the small business and personal finance portal of TheStreet.com Network, discusses the “Little Reasons for Big Insurance Hikes.”

While you probably know that smoking can double the cost of your life insurance policy, or that teenage boys are harder to insure than teenage girls, you may not understand all the factors that insurers use to rate policyholders and determine annual premium prices. To help you in your search, MainStreet.com talked to industry experts to compile this little list of small choices that can, in fact, lead to big increases in the cost of your insurance policy.

For example, Amy Danise, the Senior Managing Editor for Insure.com cautions against taking up a dangerous hobby, such as scuba-diving, rock climbing or sky diving, before applying for insurance. Danise adds “the same goes for ‘risky’ occupations and travel to dangerous parts of the world.” In fact, your daredevil status may cost you a policy entirely so you may want to also trade in that motorcycle.

“The rules on insurance underwriting exist as patchwork of state by state regulations with little national uniformity,” Alex Maybaum, Director of Consumer Advocacy for AnnualMedicalReport.com (a web site that helps consumers estimate their insurance costs based on their medical history), tells MainStreet.

According to Vicki Sicilain, a Connecticut insurance agent, many providers are allowed to cherry pick who they insure and, subsequently, what they will charge them. “There needs to be better legislation against it,” she says. “I have been in the industry for 23 years. I am still discovering small mistakes that will drive up your insurance premiums.”
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AOL’s DailyFinance – New Recession Rule: Don’t get Tests While Shopping for Health Insurance

AOL’s Money and Finance site DailyFinance.com reports on the connection between medical testing and insurance underwriting in “New Recession Rule – Don’t get Tests While Shopping for Health Insurance“.

Most people rush to schedule as many medical tests as possible just before their COBRA coverage runs out. But some experts now say that’s precisely the wrong thing to do when you’re shopping for post-COBRA health insurance. The problem with those medical tests is that they just might find something — and if that something requires treatment or even the potential for treatment, that can make you undesirable to most insurers.

But are these experts offering life-threatening advice — time of diagnosis is often a factor in advancing diseases? With that understood, here’s what some people are saying:

“A person applying for individual health insurance should delay any non-essential medical testing or prescription drug purchases until they have secured insurance,” says Alex Maybaum, director of consumer advocacy for AnnualMedicalReport.com. Maybaum, whose business helps people keep track of what shows up in their medical reports so that they don’t wrongly get turned down for insurance, even goes one step further. “A person seeking individual health insurance would be well-advised to request that their family members — parents, siblings and relatives — also avoid any major medical testing, especially tests for diseases with a genetic component such as cancer, Alzheimer’s and Huntington’s Disease.”

For example, Susan Brink used to cover consumer health issues for the Los Angeles Times and US News and World Report and now is a freelance writer and editor. She says she spent 30 years advising her readers to not skip their mammograms and get their medical tests on time — and then realized the new recessionary twist on her advice when it came time to shop for post-COBRA health insurance.

“I realized that taking the preventive measures I should be taking would lead to a medical paper trail that could leave me up the creek,” she said. In fact, it did. When her cholesterol measured high, it led to her being turned down for an individual policy. As a Vermont resident, Brink was able to join the state’s all-inclusive medical pool. The insurance costs her $425 a month.
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