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Old 11-09-2008, 08:57 PM   #21
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Sentiment understood and agreed. But HIPAA has provisions for sharing medical data if such sharing is part of the daily operations of the health care entity. This includes prescription fulfillment, computerized record upkeep, billing, etc.

Not being a lawyer, I can't say if sharing medication non-fulfillment falls under this protection or not. In any event, I see I am not the only won to raise and eyebrow toward this practice.
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Old 11-11-2008, 04:14 AM   #22
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If I EVER receive such a letter or my Dr gets one or a call I would be on the phone to my brother, the $600/hour attorney ,so fast the insurance company lawyer's heads woudl spin. I REALLY suspect this is a MAJOR HIPA violation and would be willing to put money where my typing is.
I am no HIPA expert, but I am curious why you think this is a violation.

Presumably you filled out some paperwork and the doctors office agreeing to allowing them to release your medical information to the insurance company.

I can't imagine an insurance company agreeing to reimburse a claims without knowledge of your medical history. "Dear Blue Cross please pay me $100,000 for the treatment of the patient you are covering, sorry we won't release his records you have to trust us that it was all necessary."
Obviously your Doctor has access to your medical records, how is your privacy being violated?

It is not much different than if two of your doctors discuss your treatment,and one doctor tells the other "Joe tells me he stopped taking the meds you prescribed, do you take him of them? Hell no the idiot will kill himself if stops taking them, I better call him up."

I agree that this is a bit too big brotherish for me, but I not entirely convinced it is a bad thing for society at large.
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Old 11-11-2008, 09:32 AM   #23
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I am no HIPA expert, but I am curious why you think this is a violation.

Presumably you filled out some paperwork and the doctors office agreeing to allowing them to release your medical information to the insurance company.
When I was doing network security I was at a conference and took a 1/2 day class on HIPAA. I didn't need to know it inside and out, since I wasn't in the medical field. However, just in that short time I saw that the intricacies of the law would pretty much ensure that nothing ever got done properly. I'm suspect there are provisions for that kind of info sharing. However, if one did wish to pursue a lawsuit a whole new class of lawyers has sprung up just for that purpose. Or Marvholly, you could just send your money to me. Either would accomplish the same thing (nothing) from your point of view.

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I agree that this is a bit too big brotherish for me, but I not entirely convinced it is a bad thing for society at large.
Big brother is always a bad thing for society at large, IMO. But it's like trying to hold back the tide.
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Old 11-11-2008, 08:45 PM   #24
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One of the main reasons I don't go to doctors unless I feel sick. Now there are studies that seem to recommend Crestor for the majority of the population. I have never had to take daily meds, except for hormone pills and I stopped them after 6 months--couldn't remember to take them--turned out they were bad for me, or so the studies state. I am a fatalist and will take my medicine when appropriate, but sure as shootin' if I see a doctor without a complaint, they will put me on something I'd really rather not take.
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Old 11-11-2008, 09:44 PM   #25
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This is a new one for me. Yesterday I received a letter from my internist. He enclosed a letter that he received from my insurance company. The insurance company notified my doctor that I hadn't refilled my prescriptions as often as they thought I should. Gee...now I have to think about my insurance company tattling me out on how often I take me meds.

I take a bone med for osteopenia once a week and I do miss once in a while but I was really surprised that my insurance company would rat me out to my doctor.

Is this a common practice?
One thing that bothers me about this is what if you got your prescriptions filled outside the insurance company? Our prescription insurance requires us to use a certain mail order firm in order for us to be reimbursed (who wants to bet that the mail order firm is owned by the insurance company?). However, those generic prescriptions are the same price or cheaper at $10 for three months' worth at Wal-mart and Target, even though they are not reimbursable. So what if you get your meds outside the insurance loop? You are still taking them but the insurance company is falsely tattling on you to your doctor, wasting everyone's time.

Maybe a little off topic, but a couple of years ago I mentioned some minor temporary back pain to my doctor during my physical. A couple of months later the insurance company calls me and wants me to work with their staff nurse, not face to face but on the phone and following their online program and reporting in to them. Completely outside the loop with my doctor. I told them I wasn't interested in their taking over my care (that should kill my chances if I ever need to get individual health coverage).
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Old 11-11-2008, 10:07 PM   #26
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I find it appalling that an insurance company would do this. An insurance company is not a medical professional and shouldn't try to act like one. The only reason they have my medical information is to determine whether or not they will pay claims, NOT to try to manage my medical care or interfere with my doctor. I don't know if it's a HIPAA violation or not, but it should be because it's a misuse of my health care information.
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Old 11-12-2008, 08:29 AM   #27
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One thing that bothers me about this is what if you got your prescriptions filled outside the insurance company? Our prescription insurance requires us to use a certain mail order firm in order for us to be reimbursed (who wants to bet that the mail order firm is owned by the insurance company?).
I use the mail order firm that has the contract with the insurance company. I have Blue Cross and their mail order prescription contract is with Medco this year. Last year it was with another drug distributor...can't remember the company tho. So, I don't think the insurance company owns the mail order drug company.
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Old 11-12-2008, 08:35 AM   #28
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I find it appalling that an insurance company would do this. An insurance company is not a medical professional and shouldn't try to act like one. The only reason they have my medical information is to determine whether or not they will pay claims, NOT to try to manage my medical care or interfere with my doctor. I don't know if it's a HIPAA violation or not, but it should be because it's a misuse of my health care information.
The thing that bothers me some is the pre-certification that is required for some procedures, etc. Maybe the doctor's offices and hospitals watch out for this more, but, I think the patient will need to be more careful with this too. Making sure that the procedure or hospital stay is pre-certified before being admitted. I guess I'm reading my insurance booklet more this year than I have in the past. (open season now). Maybe it's always been this way and I've not noticed it before.
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Old 11-12-2008, 08:51 AM   #29
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Not likely a HIPAA violation, but I understand the irritation, both by docs and patients. The insurance company's reasoning is that improving compliance will keep health care costs down.

My insurance company sends out regular educational mailings concerning chronic illnesses you have. For example, I get mailings about asthma. In the garbage they go. They are a little too slick with pretty pictures of healthy looking people jogging, etc. If a new breakthrough comes to pass I am sure I will learn about it.

My insurance company also tries to hook you up with a nurse, like someone else mentioned, to work with you on care of your chronic illness. Seemed too weird to me so I never took them up on it. But that might not be a bad service to offer. Heck, maybe I'll try it. I don't worry about my insurance "record" as it already throws me out of the market anyway.
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Old 11-12-2008, 09:59 AM   #30
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I've been watching this thread, and I just don't undertsand what people are upset about.

As Martha just said: The insurance company's reasoning is that improving compliance will keep health care costs down.

That *is* the purpose of the medication, right? And, the ins co *is* paying for it, right? And, we all want lower health care costs, right?

It's the same as your Mort co requiring you to have fire ins on your house. Makes sense, what's the problem?

Sorry, but it just strikes me as whining.

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Old 11-12-2008, 10:04 AM   #31
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ERD, I think "we" are paying for it, not the ins co--unless you know something I don't. And I might get annoyed if my mortgage company required me to use their in-house firm for insurance (which again "we" are paying for).

Not whining, just marveling at how the insurance companies want to help run our lives. Personally I don't take any prescriptions (dh has three) and see my doctor as rarely as possible so "we" are helping the insurance companies out as much as we can by paying the premiums and not using the services.
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Old 11-12-2008, 10:16 AM   #32
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I doubt there is evidence to support better patient outcomes when a prescription drug fulfullment company notifies the prescribing doctor that a patient hadn't refilled their medications.

While noncompliance is a problem it's more a matter of fears, cost, misunderstanding, or underlying self-destructive behaviors. It's rarely just a case that the patient "forgot" and needed a reminder from the prescription fulfillment company.
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Old 11-12-2008, 11:06 AM   #33
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My insurance company also tries to hook you up with a nurse, like someone else mentioned, to work with you on care of your chronic illness. Seemed too weird to me so I never took them up on it.
I'd wonder why they were being so good to you... and I'd want to know if this was a hospice nurse...
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Old 11-12-2008, 11:40 AM   #34
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ERD, I think "we" are paying for it, not the ins co--unless you know something I don't. And I might get annoyed if my mortgage company required me to use their in-house firm for insurance (which again "we" are paying for).
Not following you. We pay the ins co, and the ins co pays (a part of) our health care costs. If that medicine is to prevent further deterioration and expense down the road, then it can be looked at as an "investment", not just an "expense". That assumes the medicine does help to reduce overall costs, which we don't know (see my note to Rich below), but why would the ins co care otherwise?

Since all people with ins are paying into it, don't we want the ins co investments to pay off? That, in the long run, means lower costs for us.

If mort cos did not require fire ins on homes, we would end up paying higher mort rates due to the defaults. I think it works better the way it is.

And if anyone (NOT directing this at you bestwifeever) wants to fallback on the idea that free markets principals don't exist, and the cos will just pad their pockets with savings and customers will never benefit - I won't go there. Believe in fairy tales and wallow in victimization if you wish.

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I doubt there is evidence to support better patient outcomes when a prescription drug fulfullment company notifies the prescribing doctor that a patient hadn't refilled their medications.

While noncompliance is a problem ....
Well, I don't have numbers/info to say one way or the other. And neither do the people who are wailing about this. That is why I won't dismiss it out of hand (nor support it). I'm just questioning the wailing.

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Old 11-12-2008, 11:57 AM   #35
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Well, I don't have numbers/info to say one way or the other. And neither do the people who are wailing about this. That is why I won't dismiss it out of hand (nor support it). I'm just questioning the wailing.
Your point is well taken.

But the burden of proof on effectiveness of an exercise like this is on the implementer, not the "victim."

One more downside is that when I receive things like this, it seems to create a burden for me in that I now have to have my staff pull the chart, call the patient, find out what's going on, make a notation in the chart and close out the incident - almost all of which add little or nothing to the patient's wellbeing. Not major, but cumulatively these irritants and time drains add up. It comes with the territory when it is in the interests of the patient's usual care, but with something like this it's frankly just an unproven pain in the neck. Remember there are dozens and dozens of carriers each with their own little "tricks" like this. Tough to keep up.
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Old 11-12-2008, 12:29 PM   #36
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Hate to bring this up, but like it or not, right or wrong, good or bad, we can probably expect more of this behavior by the insurance companies. The companies are using just about every information collection and retention point available to compile information on patients. There is no apparent standard for this information collection and retention, and the patients have no control over it -- in some cases we don't even know it is being done, as in the OP's case! I have to believe that some if this info is just incorrect or otherwise wrong. Reminds me of the credit reporting industry.
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Old 11-12-2008, 02:48 PM   #37
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So it costs the doctor's office (already burdened with coordinating different insurance companies' coverage of the patient's care) and it costs us (it costs the insurance company to track our behavior, and to hire the nurses to monitor our conditions, and of course those costs are reflected in our premiums). It keeps the cost down? No, it keeps the money in the insurance companies accounts instead of paying the doctors we want to see.

ERD, the insurance companies have no money other than what their customers give them (that would be us). They are not paying for anything out of their own pockets, they are using money we give them, so WE are paying for our health care. Also, our health is not collateral unlike our homes are for mortgages--what makes sense for loan holders to require in order to protect their investment is not analagous to the health insurance industry, imho.

Rustward is probably right that we will be seeing more of this. I can see where we will have to deal with the insurance company's medical staff (outsourced overseas) before we are allowed to see our doctor.
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Old 11-12-2008, 04:42 PM   #38
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BWE, I'm not following your cost issues at all. Isn't that the case with any company? A car company increases efficiency, so it can lower costs and better compete. Well, they have no money other than what their customers give them. What's the difference?

I got the impression the ins co was doing this to try to lower long term costs - not to create more services that they are charging for? Are you saying they are "offering" this service to companies, and increasing their ins charges? That's not how I read it. The car equivalent would be offering expensive options, and trying to get you to buy up. They do that, but it is different from lowering costs with eff improvements.

Again, I cannot *know* that this practice is beneficial overall. But in general, business don't pursue something unless they at least have something to go on that makes it appear attractive. Of course, companies (and people) make mistakes and use bad judgment, happens all the time. This might be one of them, but as I said, I can't see any reason to dismiss it out of hand.

I agree that it could very well be the case that this causes an increased burden on the doctors, and the ins companies don't have to pay that. In the long run, the customers will, so it might be counter-productive overall. These things happen all the time, in every business. All you can do is push back through whatever means you have. The AMA? The company buying the ins?

Something I've never understood - it is mostly big companies paying for health insurance. So, why don't they get together more to standardize practices and work to lower costs? Just like Rich says, if they have ten different rules, that doesn't help. And if monitoring a patient's medicine usage is a benefit, it should be a benefit for all and standardized.

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Old 11-12-2008, 07:36 PM   #39
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IMO, this is very similar to the credit card company's practice of calling me if I use my card in some method that falls outside their algorithm of my normal pattern of use. While I can see the reasoning for it in both cases, I don't like it in either one. I truly believe Big Brotherism is bad for individuals in all cases, and I doubt it will be good for the companies in the long run. It will be interesting to see the first attempt to deny payment based on their tracking of your prescription use. Or maybe if your pedometer reports to them that you aren't getting your 10,000 steps in each day.

In the best case, I would hope that some companies (CC, insurance, whatever) would step up and advertise their respect for your privacy, giving me the option to choose to do business with them and have their business plan out do the busybody business plan in the open market. But in my experience, they'll probably all jump on the wagon becuse it makes it appear they are doing something positive, even if the results don't follow. See the TSA as a great example.
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Old 11-12-2008, 08:19 PM   #40
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I like it when my cc company calls. They called one day after some Napster charges. The charges were not mine. They caught it fast and I never suffered any consequence.
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