Calling Dr.Conglomerate!
September 24, 2007 4:00 PM Subscribe
Apparently, my insurance company wants to check-in, from time-to-time, with my son and discuss his health.
Forgive me. This one will go long.
Quick background:
- We pay for our own family healthcare insurance
- Our son is 20, but still on our policy. Due to HIPAA, the insurance company can only discuss his conditions with him, unless he gives them verbal or written permission to discuss his matters with us, his parents.
- He has seasonal allergies, and takes prescription meds when the crap flairs-up
-He also takes meds for mild depression
Recently, our insurance company began calling us to speak with my son to get him to enroll in a free asthma/allergy maintenance program. Every 45 days or so, they will call him up to see how he's doing with his allergies and meds (Any red flags going up for you yet?)
So, they're talking with him on the phone and, suddenly, he's asking for my DOB. WTF? What do they need that for? Seems that, in addition to this allergy program, they'd also like to enroll him on a similar program they have for people with depression.
I immediately put the brakes on and tell him to verbally authorize me to act in his behalf and give me the phone. So, now I'm talking to this person on the other end and explaining to her that this whole thing is beginning to sound highly fishy. An insurance company calling a customer every 45 days to "see how they are doing" and "discuss any issues they may be having with their health"??? Now, I'm all for altruism, but "altruism" and "medical insurance company" have never appeared in the same book together.
So, now all of my red flags are waving full-force. "What happens with this information?" I ask. To clarify, I further ask "Will whatever information my son gives you during these discussions somehow make it to the underwriting department and...oh, I dunno...result in even higher payments and/or deductibles?"
"You'd have to call the benefits department, sir, and ask them. I don't have that information."
So, I put the whole mess on hold, not really intending to ever continue.
Okay...there IS a question coming...
Were my fears warranted? Does it sound to you (as it did to me) that these "programs" are thinly-veiled attempts to find reasons to twist the dagger even deeper into my wallet? Beyond that, the whole idea of some company rep calling every month sounds suspiciously like an insurance company attempting to do an end-run around our family doctor. Like they are attempting to take-over my son's allergy and depression maintenance.
What say you? Anyone else run into something like this? Am I being overly paranoid? Or does it sound like these guys are honestly trying to pull something over on us?
Christallmighty, I hate health insurance companies.
Forgive me. This one will go long.
Quick background:
- We pay for our own family healthcare insurance
- Our son is 20, but still on our policy. Due to HIPAA, the insurance company can only discuss his conditions with him, unless he gives them verbal or written permission to discuss his matters with us, his parents.
- He has seasonal allergies, and takes prescription meds when the crap flairs-up
-He also takes meds for mild depression
Recently, our insurance company began calling us to speak with my son to get him to enroll in a free asthma/allergy maintenance program. Every 45 days or so, they will call him up to see how he's doing with his allergies and meds (Any red flags going up for you yet?)
So, they're talking with him on the phone and, suddenly, he's asking for my DOB. WTF? What do they need that for? Seems that, in addition to this allergy program, they'd also like to enroll him on a similar program they have for people with depression.
I immediately put the brakes on and tell him to verbally authorize me to act in his behalf and give me the phone. So, now I'm talking to this person on the other end and explaining to her that this whole thing is beginning to sound highly fishy. An insurance company calling a customer every 45 days to "see how they are doing" and "discuss any issues they may be having with their health"??? Now, I'm all for altruism, but "altruism" and "medical insurance company" have never appeared in the same book together.
So, now all of my red flags are waving full-force. "What happens with this information?" I ask. To clarify, I further ask "Will whatever information my son gives you during these discussions somehow make it to the underwriting department and...oh, I dunno...result in even higher payments and/or deductibles?"
"You'd have to call the benefits department, sir, and ask them. I don't have that information."
So, I put the whole mess on hold, not really intending to ever continue.
Okay...there IS a question coming...
Were my fears warranted? Does it sound to you (as it did to me) that these "programs" are thinly-veiled attempts to find reasons to twist the dagger even deeper into my wallet? Beyond that, the whole idea of some company rep calling every month sounds suspiciously like an insurance company attempting to do an end-run around our family doctor. Like they are attempting to take-over my son's allergy and depression maintenance.
What say you? Anyone else run into something like this? Am I being overly paranoid? Or does it sound like these guys are honestly trying to pull something over on us?
Christallmighty, I hate health insurance companies.
The same thing is happening to me. They've assigned a "nurse" to me who wants to "help" me. She's never met me. She knows nothing about me, so how, exactly, is she going to help me?
They asked all kinds of questions about what medicines I take and how I take them, looking for a chink in my armor to blame ME for the failure in the medicine. I would say you have reason to be cautious. I certainly am.
posted by clarkstonian at 4:41 PM on September 24, 2007
They asked all kinds of questions about what medicines I take and how I take them, looking for a chink in my armor to blame ME for the failure in the medicine. I would say you have reason to be cautious. I certainly am.
posted by clarkstonian at 4:41 PM on September 24, 2007
Response by poster: Are you sure it is the insurance company?
Well, if it isn't them, then someone is committing fraud by identifying themselves as being from my particular company.
posted by Thorzdad at 4:46 PM on September 24, 2007
Well, if it isn't them, then someone is committing fraud by identifying themselves as being from my particular company.
posted by Thorzdad at 4:46 PM on September 24, 2007
To play devil's advocate here, it is actually in the insurance company's interest that their clients get well, and stay well; the ideal client is a perfectly healthy premium-payer. These programs can be helpful (I'm not saying this one necessarily will be). Can you get some further information about what it entails, and talk to your doctor about it?
posted by aeschenkarnos at 5:04 PM on September 24, 2007
posted by aeschenkarnos at 5:04 PM on September 24, 2007
I work for a major insurance company and programs like this are very big sellers to our clients. Many of the companies that purchase our insurance really like programs like this.
In addition, if altruism is not a big motivator for an insurance company, believe that money is. A member who is not properly taking their meds or does not understand their condition is one that will often get worse and cost the insurance company more.
posted by slavlin at 5:19 PM on September 24, 2007
In addition, if altruism is not a big motivator for an insurance company, believe that money is. A member who is not properly taking their meds or does not understand their condition is one that will often get worse and cost the insurance company more.
posted by slavlin at 5:19 PM on September 24, 2007
I happen to have worked on a development project for software that is being used to provide support for precisely the sort of calls you are getting. Basically, medical insurance companies realized that a) they are in possession -- and given the state of medical record sharing these days, perhaps in sole possession -- of a fairly complete list of the drugs a patient is taking; and b) that many, many patients don't take their drugs regularly or stop taking them due to side effects without telling their doctors. Since bad drug interactions and not taking your meds tends to lead to even more expensive medical insurance claims (the asthma condition that turns into an ER visit; the diabetes that turns into a heart condition or amputated feet), the insurance companies reasoned that they could save themselves a buck and help their patients if they hire someone to check up on people. Basically, they look at the drugs you are taking and see if there are nasty interactions. And they call you up to see if you have gone off your meds or are otherwise having problems that could be addressed by playing around with dosage. I do know that asthma and depression, along with hypertension and diabetes, are particularly interesting to the insurance companies because the high rate of people that stop taking their meds and high incidence of expensive acute medical care that often results from that.
In terms of how nefarious this is, I can't help you there. I have no illusions about the state of the medical payment system, nor the nature of insurance companies. While I was on the project, this did seem like the sort of thing you want to encourage insurance companies to do - rather than denying benefits or squeezing payments to doctors to control cost (or should I say "in addition to'), they're trying to engage in preventative care and keep a chronic several thousand a year condition from blossoming into an acute, tens or hundreds of thousand dollar stay in the hospital.
Seemed like it was a rare case where the insurance companies, doctors and patients all had the same interest.
posted by centerweight at 5:20 PM on September 24, 2007
In terms of how nefarious this is, I can't help you there. I have no illusions about the state of the medical payment system, nor the nature of insurance companies. While I was on the project, this did seem like the sort of thing you want to encourage insurance companies to do - rather than denying benefits or squeezing payments to doctors to control cost (or should I say "in addition to'), they're trying to engage in preventative care and keep a chronic several thousand a year condition from blossoming into an acute, tens or hundreds of thousand dollar stay in the hospital.
Seemed like it was a rare case where the insurance companies, doctors and patients all had the same interest.
posted by centerweight at 5:20 PM on September 24, 2007
Are you sure it is the insurance company?
Well, if it isn't them, then someone is committing fraud by identifying themselves as being from my particular company.
Exactly. Make sure it isn't.
posted by martinX's bellbottoms at 5:30 PM on September 24, 2007
Well, if it isn't them, then someone is committing fraud by identifying themselves as being from my particular company.
Exactly. Make sure it isn't.
posted by martinX's bellbottoms at 5:30 PM on September 24, 2007
I think it could be good, it could be bad--insurance companies are starting to get the message that preventative care is the way to go in keeping people healthy and reducing costs. However, it could be an attempt to get info from you to cut benefits. Tread carefully and ask a lot of questions.
posted by Ironmouth at 5:43 PM on September 24, 2007
posted by Ironmouth at 5:43 PM on September 24, 2007
It's called disease management and it is a real verifiable industry. Health plans engage outside companies (or sometimes internal groups) of health professionals to follow people with chronic conditions. The idea is that a person with a chronic condition is offered nurse support over the telephone, including nurse intervention with the doctor's office if something weird is going on (like a doc not prescribing a beta-blocker post-MI, or someone with asthma having multiple trips to the ER), to increase education about the condition, its ramifications on one's life and the proper evidence-based guideline plans of care to prevent or delay costly services like ER trips, amputations, hospitalizations, organ replacement, etc. Disease management companies don't replace your doctor, they enhance the care.
(In the interest of of disclosure--I work at a major disease management company. I'm also enrolled in a disease management program.)
If you are suspicious of someone calling you on these pretenses, you can always ask to call them back. You can also check with your health plan (or employer) to see if it is a part of the person's benefit package.
In order for a health plan to "farm out" this business, numerous legal documents such as business associate agreements must be in place with both parties. In employer situations, it is illegal for employers to make decisions about people based on any information given back to them from the disease management company. Most of the time, this is aggregate information anyway, but sometimes it is not. So it's not illegal for them to see it, it's just illegal for them to make hiring/firing decisions based on it. (IANAL)
I can understand your concern about information shared, particularly about potential symptoms of depression. But consider this: if someone who has been treated for depression fails to disclose this on a health or life insurance application, it's fraud. It's withholding information, and it doesn't matter whether it's coronary artery disease or depression. Besides, underwriters have access to claims information tied to everyone on SSN and DOB anyway. But the disease management company won't have any information on this--you'll need to ask the health plan administrator.
By the way, some pharmaceutical companies have established "compliane and persistency" programs for their prescription medications, too, particularly those with bad side effects or that take a long time to work. Again, the idea is that nurse support and education on symptoms or how to cope while taking the medication will increase compliance and persistency so people will end up healthier.
This is just another resource available to help with your son's health conditions. You might consider talking about this with your doctor at your next visit, to see if it is going to be a valuable service to your doctor and your son.
posted by FergieBelle at 5:53 PM on September 24, 2007
(In the interest of of disclosure--I work at a major disease management company. I'm also enrolled in a disease management program.)
If you are suspicious of someone calling you on these pretenses, you can always ask to call them back. You can also check with your health plan (or employer) to see if it is a part of the person's benefit package.
In order for a health plan to "farm out" this business, numerous legal documents such as business associate agreements must be in place with both parties. In employer situations, it is illegal for employers to make decisions about people based on any information given back to them from the disease management company. Most of the time, this is aggregate information anyway, but sometimes it is not. So it's not illegal for them to see it, it's just illegal for them to make hiring/firing decisions based on it. (IANAL)
I can understand your concern about information shared, particularly about potential symptoms of depression. But consider this: if someone who has been treated for depression fails to disclose this on a health or life insurance application, it's fraud. It's withholding information, and it doesn't matter whether it's coronary artery disease or depression. Besides, underwriters have access to claims information tied to everyone on SSN and DOB anyway. But the disease management company won't have any information on this--you'll need to ask the health plan administrator.
By the way, some pharmaceutical companies have established "compliane and persistency" programs for their prescription medications, too, particularly those with bad side effects or that take a long time to work. Again, the idea is that nurse support and education on symptoms or how to cope while taking the medication will increase compliance and persistency so people will end up healthier.
This is just another resource available to help with your son's health conditions. You might consider talking about this with your doctor at your next visit, to see if it is going to be a valuable service to your doctor and your son.
posted by FergieBelle at 5:53 PM on September 24, 2007
In my instance, it definitely is the insurance company - they've sent me plenty of literature. I'd like to believe they had my best interests in mind, but they refuse to allow me to have the meds my doctor has prescribed because they're expensive. The medicines I do take don't work, and the insurance company knows they don't work. Instead of paying a nurse to monitor me, they should pay for the medicines my doctor has prescribed, and my condition will improve.
So no, I don't believe they are looking out for me. They're spying on me, and I really, really, really resent it.
posted by clarkstonian at 5:55 PM on September 24, 2007
So no, I don't believe they are looking out for me. They're spying on me, and I really, really, really resent it.
posted by clarkstonian at 5:55 PM on September 24, 2007
Response by poster: Well. it appears that I am hearing both sides of the coin here.
I do understand the point about insurance companies perhaps being in a better position to monitor a person's entire healthcare, as well as the rise of preventative care.
On the other hand, having personally been on the receiving end of things like 28% rate increases from my current insurer, I have an enormous suspicion of anything an insurance company does...especially if they present it as if it is a benefit to you. I just don't trust them not to use it against me.
posted by Thorzdad at 7:43 PM on September 24, 2007
I do understand the point about insurance companies perhaps being in a better position to monitor a person's entire healthcare, as well as the rise of preventative care.
On the other hand, having personally been on the receiving end of things like 28% rate increases from my current insurer, I have an enormous suspicion of anything an insurance company does...especially if they present it as if it is a benefit to you. I just don't trust them not to use it against me.
posted by Thorzdad at 7:43 PM on September 24, 2007
The way my individual healthcare works is that I am on a specific plan, and the cost of that plan adjusts upwards every now and then. The cost of the plan is the same for everyone on it, with variation based only on age and location.
Any specific personal medical history the insurance company digs up could be used against me if, for example, I lied on my application, or maybe didn't follow doctor's orders, or whatever, but it's not something that would affect my premiums. Once I'm in, I'm in, and any coverage changes must affect everyone with my plan.
This is in CA, fwiw.
posted by trevyn at 11:46 PM on September 24, 2007
Any specific personal medical history the insurance company digs up could be used against me if, for example, I lied on my application, or maybe didn't follow doctor's orders, or whatever, but it's not something that would affect my premiums. Once I'm in, I'm in, and any coverage changes must affect everyone with my plan.
This is in CA, fwiw.
posted by trevyn at 11:46 PM on September 24, 2007
Have you tried telling the caller that you specifically do not want them to call you again? Try telling them you appreciate (!) but are not interested in this program and are requesting they not call again. I think It sounds intrusive and like a nuisance. HIPPA is simply a rouse to take away our privacy. Under HIPPA (but not previously), insurance companies can share personal medical information with their "BUSINESS PARTNERS". which means, for example, if you are a diabetic, they can share your name and phone number and medical information with their "business parner" who manufactures hypodermic needles who can then in turn market their product to you. Gee, thanks government for protecting our privacy! But back on track, if you specifically ask the insurance company not to call back and then they do, cal the Department of Insurance in your state and file a complaint
posted by Lylo at 12:18 AM on September 25, 2007
posted by Lylo at 12:18 AM on September 25, 2007
Others have weighed in pretty completely, but I will say you can be pretty sure that anything (new) disclosed to them on these calls will surely end up in their files. I'd say it's a fair bet to also say that the answer to "can the impact my premiums?" is "if it's allowed by law, yes."
I'd just point out that if this service has some positive value then odds are decent it's a worthy trade-off. If it's information your son would provide the doctor then it's information the insurance company has access to - there's no secrets in that relationship, it's part of your coverage agreement. So unless you/he are willing to go to an anonymous clinic for an issue it's going to get back to them, no matter what it is.
I have no love lost for insurance companies, however I think it's worth remembering that they're a business, not an ATM. It's in their interest to minimize the amount they put out and maximize what they take in. Sometimes that's pretty evil - happily collecting premiums for years till they're asked to pay out, then suddenly crying poor when they have to liken their end of the deal. Other times that's just good for all involved, as when good preventative medicine is practiced.
posted by phearlez at 7:02 AM on September 25, 2007
I'd just point out that if this service has some positive value then odds are decent it's a worthy trade-off. If it's information your son would provide the doctor then it's information the insurance company has access to - there's no secrets in that relationship, it's part of your coverage agreement. So unless you/he are willing to go to an anonymous clinic for an issue it's going to get back to them, no matter what it is.
I have no love lost for insurance companies, however I think it's worth remembering that they're a business, not an ATM. It's in their interest to minimize the amount they put out and maximize what they take in. Sometimes that's pretty evil - happily collecting premiums for years till they're asked to pay out, then suddenly crying poor when they have to liken their end of the deal. Other times that's just good for all involved, as when good preventative medicine is practiced.
posted by phearlez at 7:02 AM on September 25, 2007
fergiebelle beat me to disease management. but she knows much more about it than I do anyway. some people pay more for coverage and attention like that though it is also vaguely icky and worrisome to me personally. I am currently working with several client companies to set up new disease management departments (interested in talking with FergieBelle more by the way so I can learn a bit more!) and it's interesting and cutting edge and kind of scary.
posted by Soulbee at 7:21 AM on September 26, 2007
posted by Soulbee at 7:21 AM on September 26, 2007
Lylo, "Business Partners" is a very clearly defined set of people. For an insurance company to share information about you being diabetic with a manufacturer of insulin needles, they would have to have some other business relationship with them, not just a marketing relationship.
posted by slavlin at 2:37 PM on October 1, 2007
posted by slavlin at 2:37 PM on October 1, 2007
Thorzdad, I read this question last week and just came across this presentation material from a service design conference held at Carnegie Mellon last month. A designer from IDEO named Mark Jones worked on a service design project for Blue Cross Blue Shield. I'm not sure if this is your insurer, but the description of the project (a link to the actual presentation is provided here—be warned, a 38mb file) sounds awfully like the experience you have described.
I can see where the good intentions come from, much as Slavlin, Centerweight, and FergieBelle have made the case for here, but clearly the problem of trust has not been adequately dealt with to make this type of insurer-consumer relationship effective.
posted by amusebuche at 5:45 AM on October 4, 2007
I can see where the good intentions come from, much as Slavlin, Centerweight, and FergieBelle have made the case for here, but clearly the problem of trust has not been adequately dealt with to make this type of insurer-consumer relationship effective.
posted by amusebuche at 5:45 AM on October 4, 2007
Response by poster: Thanks, amusebuche!
I only wish we could afford a BlueCross policy (in our state, it would be Anthem/Wellpoint)
posted by Thorzdad at 11:18 AM on October 5, 2007
I only wish we could afford a BlueCross policy (in our state, it would be Anthem/Wellpoint)
posted by Thorzdad at 11:18 AM on October 5, 2007
This thread is closed to new comments.
posted by milarepa at 4:08 PM on September 24, 2007