To give a real-world example of why this is problematic: my wife recently had surgery, and they had a follow-up a month later to remove a stent. Even though she was insured, a slew of wholly unintelligible bills from various departments at the hospital followed. When she showed up to have her stent removed, the director of the hospital's billing department told her that all past bills must be payed before they are able to remove the stent: this was a blatant lie, and the doctor overrode the decision in about 30min. Now after speaking with the nurses about this, one reveals that the collections department has a whiteboard game going on in the office where they write up their names and have an ongoing competition over who can extract the most money from patients. The hospital and its services are under no obligation to provide accurate pricing until ipso facto, and the pricing can often be changed because it doesn't stand up when placed under scrutiny. Does anyone believe a system like this is capable of producing an accurate "score"?
I'm completely onboard with price transparency, but am skeptical as to the utility of it to the consumer. I suspect a lot of people will get "oh, we thought it'd be X, but it turned out to be Y, which is 3x the price" sort of scenarios.
I'm sure "colonoscopy, clear" and "colonoscopy, with removal of polyp and pathology on it" will have different prices, but you won't know which it is until after the procedure.
Hospitals are protected businesses in the U.S. To build one you need a "certificate of need" in most jurisdictions in the United States. I.e., they are government-granted monopolies. They behave like government-protected monopolists do: they rent-seek.
If you want to see affordable hospital care you have to see the protection removed and competition allowed and encouraged.
This is happening to some degree already. Nowadays we have unprotected, standalone ERs, urgent care clinics, and specialist clinics. But it's not really enough, not yet.
> Nowadays we have unprotected, standalone ERs, urgent care clinics, and specialist clinics.
In your example the tail wags the dog. Hospitals are mostly obsolete. You have outpatient surgery in strip malls because hospital beds are capped and reduced, and Medicare began refusing to pay for bad outcomes, which are more common in hospitals.
The government-allowed monopolies are the sprawling health networks the turn medicine into a sales funnel. They are labelled with hospital branding, but the monopolist actions are all about doctors. For example, in my region, 90% of renal doctors work for a single practice.
Urgent care is a whole other animal -- that's all about the reducing standards and addressing supply shortages of primary care doctors caused by restricted supply (there are caps) and higher salaries in specialities.
“The hospital and its services are under no obligation to provide accurate pricing until ipso facto, and the pricing can often be changed because it doesn't stand up when placed under scrutiny”
That’s what’s driving me crazy. No other business can make up charges repeatedly and when found out, say “oops” and change them a little. In what way is this not fraud?
Try being uninsured. I had a woman come into my room (!) during my ER visit and ask for payment. I asked very clearly if this was covering the cost of the visit. I made it clear I understood the doctor and xrays would be billed separately. I paid. It wasn’t cheap.
I got the bill from the doctor. It was reasonable and I paid promptly. I got the bill for the X-ray and it was ridiculously low to my surprise. It was paid immediately. In my mind, I was done.
Then I started getting phone calls from a broken machine. Please call <actual silence> at <more silence> about your past due amount of <~$4000>. I assumed they were spam, but after about 10 of these calls over three days, the message variables were randomly filled or not on any given message. At no point was the message clearly about my hospital visit identified, but I figured it out by the phone number and the name of the parent company.
At this point I hadn’t even been mailed a bill. And I know they have the right address because the other bills came and I’ve only ever lived at my current house since the first time I went to this hospital.
So I went down to the hospital to sort it out. Well, they don’t have a billing department. They have “financial counseling” or something equally not what I need. And even though it was in the hours they are supposed to be there, everyone had gone home for the day.
I still haven’t paid. I haven’t gotten a bill, and I’m not entirely sure the calls aren’t just a scam someone is running.
Hopefully Congress passes medical price transparency and this game will end, and price competition can truly begin. If a hospital has to publicly announce they charge Blue Cross Blue Shield 20% of what they charge cash patients, they'll be in an untenable position and have to make drastic corrections.
I expect a lot of service providers to become untenable after price corrections, go bankrupt, get bought out by more efficient providers who remove all the unproductive staff.
Course this is all premised on Congress doing something useful, so...lol.
My wife was denied short term disability for a foot operation due to a completely unrelated medical issue. It took 6 months to reverse the idiotic decision, which of exactly what they wanted. Infuriating.
Real world example (slightly annonymized). You have a 50 FTE "billing and collections department". You can outsource, but at a certain scale it makes sense to build your own.
How do you motivate these people? Or manage their performance? Or manage a good outcome for the busieness, the payor and the client?
This wasn't a hospital setting. Much lower acuity. Upon joining they measured exactly this: CPT codes, bills, A/R, etc. 95% of the time those metrics correlate with their job: getting your complex insurance to reimburse for a procedure they administered.
It's a) not clear that's what you should measure, but let's assume it's not the worst thing in the world, b) straightforward how you can get the "evil" white board example you mentioned.
Not saying this is good or bad and American healthcare is arguably broken. But just another example to maybe calibrate your view.
Next time ask for that demand in writing. That's an easily winnable lawsuit. In fact you should just tell your insurance company that they demanded this AND tell your state's attorney general. That nonsense will be squashed immediately.
I recently had a MRI, and in the process of filling out the usual new-patient form at the imaging center, they wanted me to sign a blank LCD touchscreen. No indication whatsoever what I would be signing. Is it even a contract if you never saw the offer and thus no "meeting of the minds"?
After explaining that I wasn't going to sign a "blank check" contract (and would always need to read the entire contract before first), they eventually figured out how print the actual document. After several minutes reading the 8 page (!) contract, I found a clause I haven't seen before. After more or less normal stuff about agreeing to pay for the service, in a section about sending the bill to a collection agency if I didn't pay, they wanted me to agree to 1) pay for the collection agency and any other fees associated with recovering the debt, and 2) pay their attorney fees if they decided to take me to court over the debt.
I wounder a judge would actually enforce that clause. Agreeing to pay someone to sue yourself seems unconscionable. I told them I wouldn't sign their unreasonable contract (that wasn't the only problem) and they sent me off to have the MRI scan anyway.
I'm glad I'm not the only one. I just got a signature on a screen for a regular doctor visit and I was like, "What am I signing? There's nothing here."
She gave me a laminated card; three pages. I think she was kinda shocked I read it.
Kinda unrelated ... I was at a Wal-Greens and the checkout person wanted to scan my ID. I was like, "NO! I do not consent."
She called her manager saying, "No one has ever said this before." I asked about their data retention policy, wanted to see their privacy policy. I know this was useless, because they're not going to know. The manager said, "Unless we scan your card, you can't buy alcohol."
So I turned my bag upside down, emptied everything out and said goodbye. I no longer buy alcohol at Wal-greens (or anyone who scans my ID), and I find it disturbing I was the first person who asked.
Most people don't care about their privacy or what they're signing. It's fucking insane.
Typically the attorney fee assignment clauses go both ways, and the prevailing party has their fees paid. In some jurisdictions one sided clauses can be thrown out
Recently had an MRI as well. I was given an iPad with lots of documents to sign. Most of it was what you'd expect. Just poorly scrawl your name & initials where indicated.
The one that really jumped out to me was the Power of Attorney. Yes, the provider wanted me to grant them an indefinite Power of Attorney as part of being a patient. I asked if I had to complete this and was told I could skip it. I was really glad to see that about 1/2 the people in the waiting room had the same question.
Isn't this similar to the same trick those business loan sharks employ? They ask you to sign a "Notice Of Default" or similar document upfront, that they present to the court to get an instant summary judgement if anything goes wrong with repayment?
If I remember correctly, there might have been something about PoA in my contract. I already hand several reasons to not sign it, so I only skimmed the last ~1/3 of the document.
For comparison, I had a minor surgery (ulnar nerve release) in the surgical center across the hallway from the imaging center. I think they are part of the same umbrella healthcare company? The surgery center only wanted me to sign a short, concise contract that was mainly standard stuff (surgery always has some risk). I don't understand why an MRI (very safe, short) needs 3x-4x longer contract than surgery (always has some risk, involves a lot more people). This seems backwards.
> wanted me to grant them an indefinite Power of Attorney
Surely this should be reported to someone that could do something about it. I would hope so anyway, as that seems like a dark pattern that could be litigated.
Depending on the situation, it could be reasonable to argue that you were under duress or undue influence to sign the contract. This is all situation dependent, of course, but it is probably rare that an individual would have the resources and wherewithal to win such a case anyway (which is another problem).
When you sign the LCD screen without the ability to see what exactly you are agreeing to, that gives you ammunition if needed later in court. When you sign on paper there is less wiggle room for you.
Just sign "No contract provided" and hand it back like it's no problem. If the employees don't care to actually give you a document, what are the chances they are going to scrutinize your "signature?"
I’m confused, so what exactly do the hospitals want to gain from this “medical” credit score?
If the hospitals simply want to gain insight on your ability to pay your medical bills, wouldn’t your “normal” credit score be able to provide that insight.
What’s different between your “medical” credit score and your normal credit score?
Edit:
Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.
I'm with you, not paying medical bills affects your credit score the same way as any other bill. To me, it seems like it's just another service for the credit unions to make money on, while giving private hospitals some legal protection.
Medical debt is regarded less harshly in FICO 9. I am not sure how widespread the use of FICO 9 is currently among credit bureaus but it is the latest standard.
It is possible that in non-emergency situations, the vast majority of situations, a hospital may deny or change the quality of care based off of your likelihood of paying it off. No one knows the difference between a "medical" credit score and a normal credit score, but we do know that this special, secret credit score is being used to calculate patient treatment.
Wouldn’t the easier solution be to not accept patients without insurance (and low co-pays).
And given that it’s now a US requirement to have medical insurance, I’m still struggling to understand what this medical credit score is accomplishing.
Standard Credit scores are more lenient for medical debt. It takes 6 months for unpaid debt to show up and fully removed if paid in full even after it is sent to collections.
"Specifically, the NCAP prohibits adding medical debt to credit reports until after 180 days from the time the account was reported to the credit reporting agency. It also mandates the removal of previously reported medical collections that have been or are being paid by insurance." [1]
Medical debt can still be added to your credit report.
They might want people to be afraid that if they don't pay their bills, they might die. Since the threat of debtors' prison is no longer viable, I guess.
Moves like this erode my opposition to nationalizing the entire US health-care sector. If they're going to cartelize or confederate, patients--which is to say everyone in the country that lives and breathes--will also want a seat at the table.
From a more generous perspective, this may be a tool for price discrimination. Hospitals will charge based on what they think the patient can pay, rather than the actual costs of providing the care. When you receive care, you will be billed for a number that is calculated to make you sigh, flinch, or wince, but not call a bankruptcy lawyer.
This is a symptom of illness in the system, and leaving it untreated seems like a bad idea.
I bet 'Likely to be litigious' score is part of that Score. Physicians and hospitals would kill to see such a score before they start treating new patients
> Edit: Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.
This is true, but many life-saving treatments (such as chemo or radiation treatment for cancer) are not "emergency" treatments, despite being necessary and somewhat urgent.
The legal obligation hospitals have is that they must treat you if you are have a life-threatening emergency happening. That treatment can be the minimal amount needed to stabilize you so that you aren't at immediate risk of death. There is no obligation to treat you beyond that, nor to engage in follow-up care.
In Switzerland private hospitals will calculate the possibility of success in your case and if it is too low you will not be accepted, because they want to keep their success rates high... Maybe such "Medical Credit Scores" could be used for the same reasons...
I believe medical bills over $100 no longer count against your credit score so of course that created an opportunity to break them out and market them specifically
I think you’re viewing the problem backwards. It’s not that they intend to send out a standard bill and know in advance who can pay. It’s that they intend to send out bills scaled to people’s ability to pay.
It’s probably more profitable for them to send a small bill to a poor person than a large bill that is never collected. It’s definitely more profitable to throw the most ludicrous bill at those who can and will pay whatever cost is sent at them. You can also adjust the kinds of treatments given according to likelihood of profit.
I wouldn’t be surprised if the latter case is illegal (or happening or not). I’m pretty sure the former case is perfectly legal, though symptomatic of a bigger problem.
IANAL. It is not a HIPPA violation if Experian has signed a BAA with the hospital. It's on the hospital to perform the due diligence checks, to verify that Experian's capable of upholding the terms of the BAA.
This article talks about how Experian have SOC-2 issues, which is a cause for concern, but smaller hospitals with tighter budgets could be inclined to look past it.
In general, it's important to understand that HIPPA doesn't prevent data from being shared, it gives it a legal framework to be shared within. When things go bad, the HIPPA-associated paperwork provides a roadmap for assigning liability.
Minor point, but it's HIPAA with two A's, not two P's.
HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).
Further, it may be allowed under permitted uses and disclosures as-is, without authorization under the language for payments. I couldn't tell from the article, but the health systems could simply decline to treat you without your authorization for the credit check.
Separately, people love to make healthcare into the bad guy, but it's not a monolith and there are hospitals closing down because they are losing money. There is a systemic problem in the US here, and I bet this is those 2nd/3rd tier markets in smaller systems that can't absorb defaults like nationals can.
> HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).
HIPAA does not preclude hospitals from sharing data with business partners as needed to conduct their business affairs, assuming those partners likewise comply .
HIPPA protects you from gossipy front desk people. The rest is a joke.
Your prescriptions, hospital admissions, radiology orders, etc are in the hands of any of a dozen third parties before your claim is processed. It is trivial to un-anonymize the data.
I recently received treatment for Hodgkin's Lymphoma and have been trudging through bills for the past 3 years. I've found that most if not all of my medical bills contained errors, which had I not looked into, would've cost me in excess of $10k+. The most common error was the billing department submitting a bill to my insurance company months after the date I received the services. I wrote a post explaining how I used python OCR to look for these discrepancies.
My father is also a pharmacist (and now owns a pharmacy) and he constantly tells me horror stories about the cat and mouse game that insurers play with patients, where they have doctors prescribe and offer discounts on specific drugs, depending on what is most profitable. He pointed to an interesting bit of software [1] that uses machine learning to find the best margins.
I could seriously go on and on about all the insanity that is our healthcare system. These problems runs deep, from top to bottom.
The medical system in the US is so awful that I already avoid getting medical care unless it's absolutely unavoidable. I guess I need to add "never go to a private hospital" to that habit.
Same here. Just went to an emergency room with a fever and was charged $700 for 5 minutes with a doctor who told me to go home and stay in bed. I have insurance and had to spend several hours on the phone to get charges reduced to 240.
I've worked extensively with credit bureau data, and there's a fair bit of misinformation both in the article and the comments.
First, bureaus get very little detailed information about the episode of care that led to the medical bill: essentially, they'll just get info on when the bill was due and what amount on it is still overdue, plus enough info on the patient to match it to the right person (name, address, phone, SSN if available). HIPAA and similar legislation allows the sharing of billing data like this, and no other PII (or any PHI) gets shared in the process.
Second, medical debts have been a part of bureau data for a while now. What's new here is that Experian is trying to build a machine learning model on it to try to sell the model as a new product. I've never worked for any of the bureaus before but know many people who do, and in general, these specialized scores seldom sell well, but since the marginal cost to Experian is low (let a few data scientists at it for a few weeks), they still put out new ones anyway. Even things like new FICO/Vantage scores like the new FICO that's been in the news lately tend to take a while (on the order of years) to make it out into the wild since lenders like to have consistency in their processes as long as possible.
Third, it's actually beneficial to most consumers to have medical debts split out of the bureau data explicitly. Most big lenders use raw bureau data much more than the aggregated credit scores, and since the US medical system has so many distortions that correspond more to broken processes rather than a person's creditworthiness, many exclude medical debts from consideration explicitly, and others implicitly as models they build don't often find those attributes as useful as others.
All in all, it's good to be thoughtful about how information like this is disseminated and used, but the dire warnings of the article are really not warranted in this case.
Great. Now Experian gets to decide whether you can the surgery you need. They also decide whether you can get a job, rent an apartment, and whether you should remain in police custody [1].
Readit News
Forcing hospitals to disclose prices:
https://www.nytimes.com/2019/11/15/health/list-hospital-pric...
Though the hospital industry is fighting it, so we'll have to see if the rule survives.
I'm sure "colonoscopy, clear" and "colonoscopy, with removal of polyp and pathology on it" will have different prices, but you won't know which it is until after the procedure.
If you want to see affordable hospital care you have to see the protection removed and competition allowed and encouraged.
This is happening to some degree already. Nowadays we have unprotected, standalone ERs, urgent care clinics, and specialist clinics. But it's not really enough, not yet.
In your example the tail wags the dog. Hospitals are mostly obsolete. You have outpatient surgery in strip malls because hospital beds are capped and reduced, and Medicare began refusing to pay for bad outcomes, which are more common in hospitals.
The government-allowed monopolies are the sprawling health networks the turn medicine into a sales funnel. They are labelled with hospital branding, but the monopolist actions are all about doctors. For example, in my region, 90% of renal doctors work for a single practice.
Urgent care is a whole other animal -- that's all about the reducing standards and addressing supply shortages of primary care doctors caused by restricted supply (there are caps) and higher salaries in specialities.
That’s what’s driving me crazy. No other business can make up charges repeatedly and when found out, say “oops” and change them a little. In what way is this not fraud?
I got the bill from the doctor. It was reasonable and I paid promptly. I got the bill for the X-ray and it was ridiculously low to my surprise. It was paid immediately. In my mind, I was done.
Then I started getting phone calls from a broken machine. Please call <actual silence> at <more silence> about your past due amount of <~$4000>. I assumed they were spam, but after about 10 of these calls over three days, the message variables were randomly filled or not on any given message. At no point was the message clearly about my hospital visit identified, but I figured it out by the phone number and the name of the parent company.
At this point I hadn’t even been mailed a bill. And I know they have the right address because the other bills came and I’ve only ever lived at my current house since the first time I went to this hospital.
So I went down to the hospital to sort it out. Well, they don’t have a billing department. They have “financial counseling” or something equally not what I need. And even though it was in the hours they are supposed to be there, everyone had gone home for the day.
I still haven’t paid. I haven’t gotten a bill, and I’m not entirely sure the calls aren’t just a scam someone is running.
tuition cost = how much you can borrow + how much you can pay
What is strange is why do we stand for huge price discrimination in college and medical care, but not for buying a candy bar?
In the way where you buy the legal definition of fraud from the senate.
I expect a lot of service providers to become untenable after price corrections, go bankrupt, get bought out by more efficient providers who remove all the unproductive staff.
Course this is all premised on Congress doing something useful, so...lol.
Deleted Comment
How do you motivate these people? Or manage their performance? Or manage a good outcome for the busieness, the payor and the client?
This wasn't a hospital setting. Much lower acuity. Upon joining they measured exactly this: CPT codes, bills, A/R, etc. 95% of the time those metrics correlate with their job: getting your complex insurance to reimburse for a procedure they administered.
It's a) not clear that's what you should measure, but let's assume it's not the worst thing in the world, b) straightforward how you can get the "evil" white board example you mentioned.
Not saying this is good or bad and American healthcare is arguably broken. But just another example to maybe calibrate your view.
That's nuts.
What has changed about healthcare in the last 20yrs to drive up the cost of insurance premiums and pretty much everything?
I hope your wife has made a full recovery!
I recently had a MRI, and in the process of filling out the usual new-patient form at the imaging center, they wanted me to sign a blank LCD touchscreen. No indication whatsoever what I would be signing. Is it even a contract if you never saw the offer and thus no "meeting of the minds"?
After explaining that I wasn't going to sign a "blank check" contract (and would always need to read the entire contract before first), they eventually figured out how print the actual document. After several minutes reading the 8 page (!) contract, I found a clause I haven't seen before. After more or less normal stuff about agreeing to pay for the service, in a section about sending the bill to a collection agency if I didn't pay, they wanted me to agree to 1) pay for the collection agency and any other fees associated with recovering the debt, and 2) pay their attorney fees if they decided to take me to court over the debt.
I wounder a judge would actually enforce that clause. Agreeing to pay someone to sue yourself seems unconscionable. I told them I wouldn't sign their unreasonable contract (that wasn't the only problem) and they sent me off to have the MRI scan anyway.
She gave me a laminated card; three pages. I think she was kinda shocked I read it.
Kinda unrelated ... I was at a Wal-Greens and the checkout person wanted to scan my ID. I was like, "NO! I do not consent."
She called her manager saying, "No one has ever said this before." I asked about their data retention policy, wanted to see their privacy policy. I know this was useless, because they're not going to know. The manager said, "Unless we scan your card, you can't buy alcohol."
So I turned my bag upside down, emptied everything out and said goodbye. I no longer buy alcohol at Wal-greens (or anyone who scans my ID), and I find it disturbing I was the first person who asked.
Most people don't care about their privacy or what they're signing. It's fucking insane.
PhilosophyTube recently posted a great video essay (Socratic dialogue?) that explores that exact situation.
https://www.youtube.com/watch?v=fCUTX1jurJ4
The one that really jumped out to me was the Power of Attorney. Yes, the provider wanted me to grant them an indefinite Power of Attorney as part of being a patient. I asked if I had to complete this and was told I could skip it. I was really glad to see that about 1/2 the people in the waiting room had the same question.
Isn't this similar to the same trick those business loan sharks employ? They ask you to sign a "Notice Of Default" or similar document upfront, that they present to the court to get an instant summary judgement if anything goes wrong with repayment?
If I remember correctly, there might have been something about PoA in my contract. I already hand several reasons to not sign it, so I only skimmed the last ~1/3 of the document.
For comparison, I had a minor surgery (ulnar nerve release) in the surgical center across the hallway from the imaging center. I think they are part of the same umbrella healthcare company? The surgery center only wanted me to sign a short, concise contract that was mainly standard stuff (surgery always has some risk). I don't understand why an MRI (very safe, short) needs 3x-4x longer contract than surgery (always has some risk, involves a lot more people). This seems backwards.
Surely this should be reported to someone that could do something about it. I would hope so anyway, as that seems like a dark pattern that could be litigated.
Yes. It's a normal and enforceable clause. It's very common in all kinds of contracts.
If the hospitals simply want to gain insight on your ability to pay your medical bills, wouldn’t your “normal” credit score be able to provide that insight.
What’s different between your “medical” credit score and your normal credit score?
Edit: Additionally, there are laws in place in the US that state in emergent situations, no hospital (public or private) can deny care - regardless if you can pay or not. So the article title might be a bit sensationalized.
Really, it's disgusting.
credit unions are one of the few pro-consumer entities in the financial world, it would be a shame to smear them
And given that it’s now a US requirement to have medical insurance, I’m still struggling to understand what this medical credit score is accomplishing.
Medical debt can still be added to your credit report.
[1] https://www.creditkarma.com/advice/i/how-to-remove-medical-c...
Moves like this erode my opposition to nationalizing the entire US health-care sector. If they're going to cartelize or confederate, patients--which is to say everyone in the country that lives and breathes--will also want a seat at the table.
From a more generous perspective, this may be a tool for price discrimination. Hospitals will charge based on what they think the patient can pay, rather than the actual costs of providing the care. When you receive care, you will be billed for a number that is calculated to make you sigh, flinch, or wince, but not call a bankruptcy lawyer.
This is a symptom of illness in the system, and leaving it untreated seems like a bad idea.
This is true, but many life-saving treatments (such as chemo or radiation treatment for cancer) are not "emergency" treatments, despite being necessary and somewhat urgent.
It’s probably more profitable for them to send a small bill to a poor person than a large bill that is never collected. It’s definitely more profitable to throw the most ludicrous bill at those who can and will pay whatever cost is sent at them. You can also adjust the kinds of treatments given according to likelihood of profit.
I wouldn’t be surprised if the latter case is illegal (or happening or not). I’m pretty sure the former case is perfectly legal, though symptomatic of a bigger problem.
Every time you visit the doctor, the hospital tells experian (by querying the experian system) and then experian resells this information for profit.
This article talks about how Experian have SOC-2 issues, which is a cause for concern, but smaller hospitals with tighter budgets could be inclined to look past it.
In general, it's important to understand that HIPPA doesn't prevent data from being shared, it gives it a legal framework to be shared within. When things go bad, the HIPPA-associated paperwork provides a roadmap for assigning liability.
Liability does get assigned, and companies (providers, insurers, network providers) are held responsible, despite the popular imagination: https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf
HIPAA pertains to PHI and PII (protected health information and personally identifiable information, respectively). The fact of your office visit is not either of those if it's not linked to health information (labs, medical records, notes, itemized bills).
Further, it may be allowed under permitted uses and disclosures as-is, without authorization under the language for payments. I couldn't tell from the article, but the health systems could simply decline to treat you without your authorization for the credit check.
Separately, people love to make healthcare into the bad guy, but it's not a monolith and there are hospitals closing down because they are losing money. There is a systemic problem in the US here, and I bet this is those 2nd/3rd tier markets in smaller systems that can't absorb defaults like nationals can.
False. Directly from HHS, emphasis mine:
https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg...
“Individually identifiable health information” is information, including demographic data, that relates to:
* the individual’s past, present or future physical or mental health or condition,
* the provision of health care to the individual, or
* the past, present, or future payment for the provision of health care to the individual,
"As needed" is a definition that most patients would disagree with
Your prescriptions, hospital admissions, radiology orders, etc are in the hands of any of a dozen third parties before your claim is processed. It is trivial to un-anonymize the data.
Deleted Comment
Dead Comment
My father is also a pharmacist (and now owns a pharmacy) and he constantly tells me horror stories about the cat and mouse game that insurers play with patients, where they have doctors prescribe and offer discounts on specific drugs, depending on what is most profitable. He pointed to an interesting bit of software [1] that uses machine learning to find the best margins.
I could seriously go on and on about all the insanity that is our healthcare system. These problems runs deep, from top to bottom.
[1] - https://amplicare.com/
First, bureaus get very little detailed information about the episode of care that led to the medical bill: essentially, they'll just get info on when the bill was due and what amount on it is still overdue, plus enough info on the patient to match it to the right person (name, address, phone, SSN if available). HIPAA and similar legislation allows the sharing of billing data like this, and no other PII (or any PHI) gets shared in the process.
Second, medical debts have been a part of bureau data for a while now. What's new here is that Experian is trying to build a machine learning model on it to try to sell the model as a new product. I've never worked for any of the bureaus before but know many people who do, and in general, these specialized scores seldom sell well, but since the marginal cost to Experian is low (let a few data scientists at it for a few weeks), they still put out new ones anyway. Even things like new FICO/Vantage scores like the new FICO that's been in the news lately tend to take a while (on the order of years) to make it out into the wild since lenders like to have consistency in their processes as long as possible.
Third, it's actually beneficial to most consumers to have medical debts split out of the bureau data explicitly. Most big lenders use raw bureau data much more than the aggregated credit scores, and since the US medical system has so many distortions that correspond more to broken processes rather than a person's creditworthiness, many exclude medical debts from consideration explicitly, and others implicitly as models they build don't often find those attributes as useful as others.
All in all, it's good to be thoughtful about how information like this is disseminated and used, but the dire warnings of the article are really not warranted in this case.
[1] https://bigbrotherwatch.org.uk/all-media/police-use-experian...