Dispelling Myths About Insurance Industry Files
Many people assume that the health insurance industry has access to every piece of medical information about anyone who has ever had or used health insurance. The insurance industry does nothing to dispel that notion, although there is very little truth to it.
At present, no central recording system tracks everyone's medical records. The federal government is looking into creating some sort of plastic card with an individual's medical records on a magnetic strip, but concerns about privacy and confidentiality are slowing progress enormously, if not totally stopping it.
The Medical Information Bureau, a computer located in Boston, Mass., keeps some information, and is the source of most of the rumors about the knowledge of insurance companies.
The MIB only keeps information that accompanies applications for life, health and/or disability insurance, as well as some data about people claiming benefits under disability income policies. The MIB is a cooperative supported by the life and health insurance industry and has been around for many years. Its original purpose was to help insurance companies protect themselves from fraud.
In return for submitting information to the MIB, member companies have the right to access information from it. Companies use it as a clearinghouse for all life, health and disability insurance applications, primarily to prevent "stacking" or multiple applications but they also use it to cross-check medical information to make sure it matches what the applicant is telling them.
What information does the MIB have and where did they get it? Whenever an insurance company processes an application on someone, they report the information on that application to MIB. This includes not only what the insurance is and for how much, but also the medical and financial information that is part of an insurance application. Also, if the person was turned down or was rated up for health reasons, that information will be reported with the details of why.
Every member company routinely checks every application they receive with MIB. However, any information supplied by MIB cannot be used to directly deny someone insurance. The data in MIB can only be used by the insurance company as a guide to whether or not to expect problems and, if so, where to look for them.
For example, because of the special confidential nature of HIV status, insurance companies in California can only report HIV to the MIB as a "miscellaneous blood disorder." Although the insurance company will probably suspect HIV, they cannot turn down the application on the basis of that MIB report alone. They will go back to the applicant, however, and require him or her to take an HIV antibody test (HIV tests are legal in California for life and/or disability insurance). And, of course, once they see a positive result, they will decline the coverage.
For health insurance in California, an insurance company cannot require an HIV test or use HIV status alone to deny coverage. But you can bet that the insurance company will start looking into your medical background a lot more deeply once they see the MIB report with "miscellaneous blood disorder" on it.
Once an insurance policy is issued, no further information is submitted to MIB. The only information at MIB is the data collected in the process of an application for individual life, health or disability insurance. Insurance companies do not report medical claims information so MIB cannot track it or have any information on it. If you bought a health insurance policy six years ago and have been filing HIV-related claims under that policy for the past two years, MIB will have nothing but the initial application information on file. If you bought the policy 10 years ago and have been filing HIV claims for five years, there will be no file on you since they only keep application information for seven years.
The Fair Credit Reporting Act requires insurance companies to notify you if they intend to contact the MIB and give the information on you to them. When you apply for insurance there will be a statement near where you sign, often a small tear-off portion at the bottom of the application, that explains their intention to check with the MIB and to report their findings to it. If there is no such statement they do not use MIB. Only insurance companies may join this co-op so health service plans such as Blue Cross, Blue Shield and HMOs like Kaiser are not members. They neither supply information to it or can they receive data from it.
Individuals have a right to see their MIB file if they wish and if there is one. To see your MIB report, call them at (617) 426-3660 and ask them to send you a "Request for Disclosure of MIB Record Information" form. Or you may write them at: MIB Information Office, P.O. Box 105, Essex Station, Boston, Mass. 02112. Complete the form and return it to MIB with a check for $8 and they will send you what they have on file for you.
Remember, if you have not applied for insurance in the past seven years there will be no file.
Jacques Chambers is manager of AIDS Project Los Angeles' Benefits Program. He can be reached at jchambers@APLA.org
This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.