Three years ago I got a life insurance policy. Due to some snafus with billing (they were automatically billing my credit card, and the card expired, even though the credit card company sent me a new card with the same number) the company told me that they would reinstate my policy if I filled out some forms and mailed them a check for the missed months.

I did all of this, and they cashed the check. A month later, I get a letter in the mail, with a reimbursement check. The insurance company says that they will no longer insure me, because a check of a nationwide medical database indicated problems with my health. They said their original letter specified this check -- I checked the original letter, and this was buried in fine print so small that I literally needed a magnifying glass to read it.

Now, three years ago, this insurance company did not check any medical databases. Instead, they relied on a physical exam by a registered insurance examiner. Since that time, I've only been to a doctor twice. One time I complained of some symptoms that seemed like gall bladder problems, and the doctor ordered an ultrasound. The ultrasound did not indicate gall bladder problems, but did show that my liver was getting fatty. I discussed this problem with the doctor -- I said it was odd, because I did not drink at all. He suggested that I drastically reduce my fat intake and lower my cholesterol. He also did not believe me when I said I didn't drink.

This information must have been entered into the medical database. This means, among other things, that I will probably never be able to get life insurance or private health insurance again.

Honest to God this happened -- I found out about it today. What in the hell is going on?

There's an amazing kicker to this whole story. I can appeal this situation, as long as I do it within 30 days. However, to find out what it is that I am fighting, I must send a letter to the insurance company, who will send their report to my physician, which will take A MINIMUM of 30 DAYS to process. In other words, it is impossible to appeal the situation.

MrJim,

This sounds very much like the national database that property insurers use to check on previous claims by homeowners. You've probably read about it and the nightmare it has created for some homeowners.

The only way this is different is that it is health insurance and not homeowners insurance. The same game with a different name.

Actually, it is another way to deny people insurance. Smokers, obese people, anyone with any health problem whatsoever, imaginary or not, is out of luck.

When did this thing go into operation? Isn't there any sort of confidentiality for patients receiving treatment?

Certain medications can cause problems and lead to illnesses that you would never suspect. Check out anything you're taking, read the very fine print, study any tests the med has been involved in and what the results were (especially any problems encountered although only minor), take a look at a PDR, research the side effects, and study what's on the internet BUT DO NOT take it for granted you're being told the truth online. DO NOT use any internet so-called doctors or pharmeceutical services.

What does this have to do with medical databases?

You need to state specifically in a letter to them before the 30 days are up that you are thereby initiating an appeal. That should suffice to fulfil the time requirement. In that letter or another you can make the other necessary requests (for the report to go to your doctor). The rest can then take whatever time it takes.

I could be wrong but I believe most Doctors office now days have you fill out a little form with a lot of fine print saying they are allowed to release your medical information to insurance companies, also when you apply for insurance most insurance companies make you fill out a form giving them permission to ask for any medical information on you.

This is probably the database you're referring to: Medical Information Bureau

MIB, insurance database . You can contest the information in their files. Contact the company who declined your coverage and ask for info on filing a formal request to MIB. It can be done, and I have seen MIB correct their files.

Mr. Jim - This has been going on for sometime. And it just seems to be getting bigger and more intrusive. I know for a fact, due to some previous illnesses that I have had, if I ever lose my insurance, I'll never be covered by a new provider again. That is until I'm old enough for medicaid, if it is still available without adding "pre-existing" conditions' to limit it's coverage. It is a very frightening situation for 10's of 1000s (at minimum) of people just like me all around this country. Many choose to pay out of pocket, rather then use their insurance if at all possible to avoid getting caught in this Catch-22.

magic

Jim, I hope you will after them and I wish you luck. Sadly, this is just another example of how broken our system is......... and why we need a nationalized healthcare system
sans HMO's and insurance companies.

A bigger question, if these type of errors happen just within the inusrance industry, what will happen when all hospitals, doctors, dentists, health departments and pharmacies, share in the same information databases, and also add to the information in a patient's file as they see fit. ? Will this info be strictly objective? It's one thing to have to argue with your insurance company to get coverage, its another to have to argue with your physician to get treatment. Could this database be used as a means of discrimintation against different groups of people?( gays and lesbians for instance)? What if the database included subjective opinions of medical personnel, including doctors, dental hygentists, billing clerks for the hospital? What if you were not very nice while discussing your bill with that clerk? ? We are talking about one huge headache at the end of the day trying to track down erroneous information, placed into a national database, by any possible 2,000,000 health care workers. MIB is a peice of cake , you can file an appeal and MIB does have a formal review and will change any and all information, not only in their records, but they will go back to the reporting insurance company and request they correct their initial MIB, so any Underwriter, looking at MIB hits, will see previous MIB corrections.

Yes, and if you know a lawyer or have access to a legal clinic, see if this letter can be sent on the lawyer's/clinic's letterhead. Also, send this letter by registered mail.

Send a certified letter return receipt demand a copy of the information the
insurance company used to determine your ineligibility.

If you have a attorney, have him send it. State that you are disputing it in writing
and the 30 day period they state will start when you have copies of your
insurance file. But do it today.

Can't happen. HIPAA prohibits sharing of medical information without your written consent. Personally, I would be very careful consenting to sharing this information without knowing exactly what's in it.

Don't know if will help you now but the Hippa act deals with restricting access to your medical files.

http://www.hhs.gov/ocr/hipaa/

Not only do great minds think alike they seem to also do it in unison

Problem is there are many ways to get around HIPAA. For instance, when applying for new insurance, one of the requirements still can be that you sign consent to review previous medical information. Insurance Companies seem to believe that if they are going to cover you, they are entitled to have access to past medical history. I'm not saying it is legal, I am saying it is done all the time.
Also state laws vary, California has very strong "equal access for all laws." Employers are currently getting around this buy purchasing Insurance in states where the laws are not as strict. Since the coverage originates in that state, if you are covered, you are only protected by the laws of that state. Had it happen to me this year. Right before the Kerry election as a matter of fact. Had a long hospitalization denied and it took months of threatening, appealing and outrage before they agreed to cover an illness that was originally denied.

For the life of me, while protected SS is EXTREMELY important, I believe we should be directing our House and Senators through SCREAMING OUT LOUD the need for
change in the medical insurance industry.

mtnmagic -

Have you checked out the "Red State Tour" video clips that Jason psoted. It's on the Truthout webste. Anyone, many of the people who voted for Bush who were interviewed did agree on one thing - the need for healthcare. It is a crisis. Even the red voters in red states know it.

I did have to sign an agreement that they could access this database (without really knowing it -- it was in that magnifying-glass small print I referred to) but my question is -- how did it get in this database to begin with, without my consent?

HIPAA is a joke, it only protects the Medical Institutions from having to release medical records to the patient themselves. Read the actual legislation, everybody, including your neighbor's dog, has a right to see your medical information, everyone, but you.. However, for a fee, they will share their invoices with you, showing insurance payments, ICD codes included, and of course patient billed items.

Just reading all of this is making my blood boil.

Jim - The way I understand it, and remember, I'm a lay person, when you authorize your insurance to pay your benefits directly to the provider, it somehow authorizes them to request info to the Insurance Big Brother in the sky. If you choose to pay your medical bills yourself, then request reimbursement, it still requires the insurance company to review your medical records, hence their ability to report you for an illness. A classic example of damned if you do, damned if you don't.

Again, the data base has been in place for years. It just keeps getting stronger and stronger. You have the right to review all your medical records and have copies made for you (for a fee of course). Then you can see what is involved in the doctor's notes. Remember, for them to claim reimbursement, they must make your condition as "medical" as possible. Warning: You may not recognize yourself, when you review your medical records.

Problem: After reviewing your records, challenging a Dr.'s opinion, you may not recognize yourself. Unfortunately, the insurance company may have paid on the
physician's diagnosis. So you are between a rock and a hard place.

1.) Dare you question a physicians diagnosis, of which they have already been reimbursed. In other words, would you like the payment reversed?

2.) How dare you question a physician's diagnosis, when obviously you went there, to find out what the heck was wrong with you?

3.) You are diagnosed with a condition that is entered into the "registry", so help you, if you have a problem again, without the same protection, of the same coverage that really wishes you would die, so they could get rid of you.

Mr Jim, I am not a lay person, and I can tell you the following. MIB simply reports what a member Insurance Company codes. . No member company can submit MIB codes without proof of such condition. Example, information must come from the signed application, a physician , the insured, the spouse of the insured, public records , commercial investigative corp (Equifax ), current paramedical or MD exam, or prior claim within the same company. However, all people make mistakes. If the information in question is false, then write to MIB and ask for a formal review of such information, insisting that the inaccuracy, having caused a company to decline coverage, be corrected. They must investigate, and they will correct, if the information is wrong. Sometime it is as simple as a mistaken identity. Same name, same birth year and month, and someone calls it a match without looking further. Of course, if the information is correct and accurate, then there is nothing you can do about it. Sorry!!!!!