Health Insurers Are Vacuuming Up Details About Customers

https://www.propublica.org/article/health-insurers-are-vacuuming-up-details-about-you-and-it-could-raise-your-rates

by marchenko • 8 years ago

193 250 8 years ago

mtgx• 8 years ago

This will ensure the death of the private healthcare system. It won't happen overnight, but eventually the private/hybrid healthcare system will have no redeeming qualities other than to extract as much profit as possible out of anyone's health issues. That's when no one will support it anymore (except the politicians taking bribes to support it).

Analemma_2• 8 years ago

Why the downvotes? He's right. The thing about insurance is that the only reason it works is because of imperfect information about the future. The more accurately people can be priced, the more pointless private health insurance becomes: the expensive patients (pre-existing conditions, or just people with bad luck) will get accurately priced and have impossible premiums and won't bother, and the cheap patients will realize they probably don't need it, take a gamble and also not bother. Microtargeted health insurance will be its own undoing.

mindcrime3• 8 years ago

It sounds like you're doing something that most people do, despite it being incorrect. That is, conflating "health care" and "health insurance". Everybody has gotten so conditioned to the idea that "health insurance" pays for everything health related, that we all seem to take this for granted. But it doesn't have to be so.

I believe that our goal should be to reduce the cost of health care so that most of it can be afforded without insurance - with insurance then returned to its role as a hedge against the more extreme/unlikely events.

mindcrime3• 8 years ago

This will ensure the death of the private healthcare system.

We don't have a private health-care system, and haven't for a very long time. The government and big corporations[1] are so deeply entwined into the current system that it barely approaches anything that could be called "private".

[1]: Corporations are a legal fiction which depend on the State for their existence.

poulsbohemian4• 8 years ago

will have no redeeming qualities other than to extract as much profit as possible out of anyone's health issues.

We're already at this point, but I don't see why you think that will be the death of the private healthcare system, see:

politicians taking bribes to support it

ohazi• 8 years ago

Isn't this super illegal? Who are the lawyers at these companies who are signing off on these projects?

throwaway57522• 8 years ago

No. Using that data might be. In any case, it's only illegal if the Supreme Court interprets it to be illegal. If you have been following the recent years of Supreme Court decisions/dissents it will not be comforting.

icebraining• 8 years ago

Can you point to the cases that concern you? I haven't been following it closely enough.

kevin_b_er2• 8 years ago

What would be illegal? As long as corporate profit is viewed as more important than human health and safety, there will be no laws against such things. The Republican-controlled supreme court likes to rule that corporate "rights", due to corporate personhood, cannot be contained or curtailed in favor of human ones.

smileysteve• 8 years ago

And it could raise your rates

And it could lower your rates.

Analemma_2• 8 years ago

Please be serious here: stuff like this never causes prices to go down, only up. As information becomes perfect, the "problematic" expensive patients will see their premiums rise to the level of their actual cost to the system-- which is huge and impossible to pay, so they'll drop out-- and premiums for everyone else will stay the same, except with the added anxiety that anything you do could cause your rates to go up at any time.

yourapostasy• 8 years ago

And it could lower your rates.

Lack of a national competitive market for healthcare insurance in the US ensures an oligopoly within each state, and thus argues against your reply. Also, keep your eye upon demographic rate trends, not individual rates.

In other words, for the same demographic over time, have rates been going up or down as the insurance market consolidates players over the past few decades? The trend is inarguable [1]; it is a monotonic function. What data do you have that convincingly advocates including data brokering of lifestyle data into insurance actuarial calculations makes a material change in this function or the marketplace?

[1] https://www.thebalance.com/causes-of-rising-healthcare-costs...

s73v3r_3• 8 years ago

No, it will never be used for that.

exabrial2• 8 years ago

That's ok with me? I wish it were like life insurance where they can ask you anything and then you get that rate locked down for the term.

I also actually liked the proposal in Congress that got rejected: allow people to make their own groups. So if you are a person who likes to work out and get your fat levels tested once a year, you could join a group of like minded individuals and insurance companies would bid to insure your group.

ceejayoz8• 8 years ago

That's ok with me? I wish it were like life insurance where they can ask you anything and then you get that rate locked down for the term.

That's an understandable attitude for a healthy person.

What is the person born with a disability or a gene making cancer, Alzheimers, heart disease, etc. likely supposed to do?

"Your insurance premium is $25k/month. We take checks!"

sDlEzAtyoNAz10• 8 years ago

If they can't afford to pay anyone enough to insure them, they should ask for charity, because that's what they need.

exabrial2• 8 years ago

For the vast majority of people, this is all the healthcare they need, and an efficient system should/could run that way!

I think you misunderstood something I said, however. A "risk pool"'s rates can only be decided by non-preventable risk factors of that pool. The examples you give don't reflect that well: some cancers are preventable, Alzheimer's cause and treatments are not well understood, and most heart disease is preventable.

For someone with a childhood disease, for instance, they could possibly fit into a certain risk pool, but they likely won't. Any "risk pool" based insurer will not have the funds to cover them anyway, and forcing them to cover the extreme cases has shown to leave more people without healthcare. [Take the case in Iowa, where a single person caused 30,000 individuals to lose their insurance. That is not an acceptable outcome!]. Right now, the best answer on how you handle these extreme cases will have to be a combination of Medicare and Charity, as they are the only organizations with a pool of money big enough to help them.

frockington9• 8 years ago

That does souns appealing. I'm all in for a mandatory annual weigh in and fitness test

wild_preference• 8 years ago

I’d go a step further and give people discounts if they even try to eat healthy. Amazing how long I can go shopping cart peeking without spotting a single vegetable or fruit.

amorphid3• 8 years ago

Incentives are different. Life insurance companies have an incentive for you to not die. Health insurance companies have an incentive for you to not live (e.g. you don't that organ $$$$$$ transplant you need to live).

Health insurance is cheaper when more people are in it, not fewer. If you start offering discounts to the healthiest people, it gets more expensive for unhealthy people. So let's say the sickest people no longer have insurance. Now there's a new group of unhealthy people in the insurance pool. So you raise prices for them, and they get kicked out, too. Eventually you get to the point where insurance is not useful, because nobody needs it at all, as the insured people don't get sick. Until they do get sick, at which point they get kicked off the insurance plan. Health insurance that doesn't insure is basically fraud.

If you want to drive down the health related costs of healthcare, reduce the things that make people sick.

sDlEzAtyoNAz10• 8 years ago

So you raise prices for them, and they get kicked out, too.

They only get kicked out if no one will offer them prices that they can afford and that they want to pay for. Why do you expect that would happen?

Until they do get sick, at which point they get kicked off the insurance plan.

It seems like that would be solved by treating health insurance like term life insurance as the person you're replying to suggested.

chicob• 8 years ago

I do not think that this is a good idea, for various reasons.

1) Letting peer pressure and self censorship to police our habits is the end of individuality and freedom. This is exactly what China is trying to achieve with that horrible social credit system. It also inverts the logic behind healthy practices: today you run because it makes you feel good; tomorrow you run because you can't afford to be left behind and lose insurance. This kind of thing really lowers the bar on the respect of privacy and dignity because it is basically large scale surveillance in exchange for cheaper insurance.

Take car insurance: are you willing to give insurance companies full access to your GPS and tachometer data just so you can prove you're a good driver (in their own terms) and pay a little less?

2) What is healthy today might not be healthy tomorrow. Imagine some food is considered healthy in 2020, and you happen to eat lots of it, but in 2050 it turns out it's the other way around.

And 3) this all boils down to the reason why, in general, associating people in groups and then judging individuals accordingly is unconstitutional in so many countries. That group may be gay people, black people, people that voted Left or some other group that you cannot leave or join because of some arbitrary definition. And is also worth considering that the group to which you belong can vote a change on its definition that leaves you out with no appeal, the worse case being some AI deciding that you're done.

jesseryoung• 8 years ago

Heard about this article on NPR this morning. Thought the concern was valid but a little on the alarmist end of things.

Most of the data they need to know if you are going to be an expensive subscriber or a cheap one you're required to give them directly: Your age, your gender, your home address and the list of services you received at your doctor's visits that they were billed for.

Both healthcare providers and insurance providers know that the most efficient way to lower your healthcare costs is to get the patient to go to preventive care visits and keep them out of the ER. It doesn't matter how much money you give them each month, if they can prevent you from going to the doctor all together it's 100% (roughly) profit.

lvspiff2• 8 years ago

I work alongside healthcare informatics and I got to say this is entirely the case from what I have experienced - the less you go to the ER the more the insurance profits. All of our research and data collection revolves around people getting tests and treatment PRIOR to something major happening. Regular bloods tests, proactive bp and a1c monitoring, etc lead to better heart disease and diabetes treatments so you don't go into a crisis. The collection of data allows treatment to be better for the population not to charge a higher rate to specific people. Keeping you out of the hospital is monumentally cheaper than a couple doc visits a year for a couple lab tests.

FireBeyond4• 8 years ago

Insurers contend they use the information to spot health issues in their clients — and flag them so they get services they need.

Horse shit. And I say that as someone who writes claims management software for the healthcare industry.

I challenge ANY health insurer to provide examples of this. Of course, they won't, because they'll cite "patient confidentiality", but that just doesn't happen.

They've wanted to do this for years, though, and try to. Requests to be able mine claim data for familial predispositions to diseases was one that we fended off multiple times.

sidlls2• 8 years ago

You may have fended it off but I assure you there is a whole industry devoted to using claims and other health data to manage care and costs. Insurers are primary partners of these companies and act as both providers and consumers of the data.

Not just insurers, but big hospitals and provider networks, too.

pishpash2• 8 years ago

We're going down some kind of bizarre path. Insurance is ultimately about risk sharing. If every risk is modeled then there is no insurance, just expensive prepayment.

FireBeyond4• 8 years ago

Very true. We're not perfect, but I am at least happy we made an ethical and moral (and in some cases legal) choice that I'm much more comfortable with than some others.

s73v3r_3• 8 years ago

"You may have fended it off but I assure you there is a whole industry devoted to using claims and other health data to manage care and costs. "

If by "manage care and costs", you mean kick people off insurance and deny claims, then sure.

pishpash2• 8 years ago

And people voluntarily spend money to send their DNA to some random websites. Sure, they don't use it in this way now, but for how long can they hold off on the temptation?

duxup2• 8 years ago

I have read a few stories about some small insurers who were using health data to address ongoing issues and help people get more consistent care.

The catch was for it to work it was a very labor intensive task to have someone work with the customer.

Granted it was more of a story about how things should work than how they do.

FireBeyond4• 8 years ago

Sure. That's arguably more the job of the PCP, to manage ongoing issues, just as in my other role as a paramedic, we are running 'community medic' programs to handle non-emergent calls and patients who are 'frequent fliers'.

Using this data to spot "chronic conditions being treated acutely or not at all", I admit I can see. But beyond that, not so much.

cowkingdeluxe• 8 years ago

I am curious if they will be able to use this data to raise rates if the pre-existing coverage is removed ( https://www.npr.org/2018/06/08/618263772/trump-administratio... )?

I presume that it would be smart now for people to use certifications of creditable coverage?

lvspiff2• 8 years ago

You'd be surprised - your not seeing the informatics side I'm guessing - they take all the data from the claims system and use it to check if a patient is over 55 and has had a colonoscopy, or female and over 45 and hasn't had her annual breast exam. Things like that are common practice for major insurance carriers (see unitedhealth, blue cross, humana, etc) to notify their customers of opportunities.

kolpa• 8 years ago

Insurers are paid in premiums, not health outcomes. An insurance company is incentivized to help avoid costly claims, but if you are likely to make costly claims, and they can't drop you, they are incentivized toward healthcare choices that kill you before you need long-expensive term care.

Spooky232• 8 years ago

They do it in two ways that I have seen.

If you have a prescription for an off-label use of a drug that is commonly used for other diseases with high maintenance costs (say diabetes or asthma), you'll start getting newsletters about early management/intervention.

They also do subrogation. If you have something that is a high likelihood to be somebody else's (Worker's Comp, auto insurance) problem like a back injury, you'll have an investigator call to try to link an earlier incident, ER admission, etc to your current issue.

Most of the other stuff (familial predispositions, etc) are fraught with ethical problems. You can't send a random letter to a random person and suggest that they are predisposed to cancer or something.

kyrieeschaton• 8 years ago

This is complete nonsense and entirely speculative. They admit as much when they inform you they can find no evidence of any individual underwriting decision being made based on this data, which the companies strongly deny, and would be illegal. Insurance is highly regulated, both on a state and federal level. Pricing algorithms and variables are public in most states (albeit obfuscated).

What does seem to be happening is the companies are using third party data providers for marketing and market analysis, as literally every other company from your local HVAC guy to McDonald's does.

a_d• 8 years ago

Whenever someone says that AI and IoT would automate insurance underwriting, I start to fret — because it very quickly starts to imply more and more data collection. This is like pre-crime but for your health. Meaning, you start paying high premiums right away because later in life you might be at a high risk for a specific condition. (I know this already happens for smoking, but that is declared on a form — not by a company sending a drone to spy on you)

Since this is a startup forum — I believe health insurance to be so dark and morbid (with things like companies haggling with living relatives about ventilator care) — there is got to be a better way! (I realize this is more of a lament than a constructive suggestion)

richrichardsson2• 8 years ago

There is a better way, it's called single payer universal healthcare!

frockington9• 8 years ago

Please no, I don't trust the government at all to handle healthcare efficiently. And I enjoy my insurance company through work, its the equivalent to a significant raise each year

rsync• 8 years ago

"there is(sic) got to be a better way!"

There are two better ways - each at a different end of the spectrum.

You can give up entirely on government intervention in health insurance and social "goods" being pursued - everyone is on their own and "healthcare" is a private, personal matter. You can play these agency/incentive games with insurers for better or for worse and you're on your own.

We declare "healthcare" to be a public, common good and completely socialize it. Like roads and fire departments.

What these two different strategies have in common is that both of them are intelligible, reasonable and give people a framework for planning and making long term decisions.

Anything between these two points on the spectrum is unintelligible and unsustainable. You would probably be better off with (the option above that you like the least) than any option between them.

mindslight5• 8 years ago

Anything between these two points on the spectrum is unintelligible and

... very fucking profitable. I mean, the most significant part of "health insurance reform" was to penalize people if they choose to opt out of patronizing these private companies. Some reform!

I'd actually nitpick and say there are sane ways to combine the two regimes. For instance, a base level of common care, and then a functioning market for elective care, additional care, and upgrades.

gbrown• 8 years ago

It's like when the government tries to address an oversupply of luxury apartments by renting them at full price and re-renting them at subsidized rates to consumers. I forget where this happened, but it was covered on Marketplace a few months ago.

That "solution" is objectively worse than either the extreme libertarian position or the socialist position (though there are economically sensible positions between, this just doesn't happen to be one). It preserves artificially high demand for these luxury apartments, costs taxpayers a ton of money, and around the waste-cycle we go.

bovine3dom5• 8 years ago

We declare "healthcare" to be a public, common good and completely socialize it. Like roads and fire departments.

1. Lots of places have private roads without much trouble. France's autoroutes are perhaps the most famous example.

2. Many of the world's most successful universal healthcare systems are run at least partially privately. The first point of contact one has with the NHS, for example, is through a general practitioner via medical practice, all of whom are private businesses (free at the point of use).

I don't see why you think a hodgepodge of private and public, as exists in many places already, would be such a problem; I totally fail to see how making everything completely private would be a better solution than that. You'd end up with horrendous lemon-dropping.

Gibbon15• 8 years ago

You can give up entirely on government intervention in health insurance and social "goods" being pursued - everyone is on their own and "healthcare" is a private, personal matter.

Except Kenneth Arrow showed market based health care doesn't work. That was in 1963. Since then the US has pursued market based heath insurance for ideological reasons and... that doesn't work without vast government subsidies. The government pays enough subsidies to cover a socialized system.

http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

stakhanov4• 8 years ago

I think there's something to be said IN FAVOR of the notion that person A's health risks don't trade off against person B's health risks at a 1:1 rate.

The crucial thing however, in a data protection sense, is that there are too many people who don't realize the implications of giving away data about themselves. A shopper signing up for a loyalty card scheme in a grocery store might sign a blanket waiver allowing the scheme operator to pass the data on to whoever they please to be used in whatever way they want, without thinking about the possibility that it may end up in places where it won't serve their best interests.

So there should be something similar here to health warning on cigarettes. Kind of like "Warning: Signing up for this loyalty card may make you uninsurable."

Also, I think there should be legal infrastructure in place to ensure that there are certain rights that you can't sign away as part of a contract that, in practice, you don't have the option not to sign (like Google's general terms & conditions).

koolba• 8 years ago

Which is also why you should use a fake phone number, name, etc for those loyalty cards.

Also a neat trick is to just (XYZ)-867-5309 as someone already signed up with the number from that song and it’s not a real number.

jasonjayr• 8 years ago

It's a real number in the 401 area code.

https://www.askgem.com/

See the contact info in the lower left of the page.

stakhanov4• 8 years ago

I agree that "gaming the system" is usually the most practicable way to deal with this stuff in real life, but that doesn't mean it shouldn't be sorted out on a more principled basis eventually.

staticautomatic9• 8 years ago

I buy data from LexisNexis. AMA.

19967• 8 years ago

What do you have from the healthcare part now? Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses because hipaa?

How is the data linked? ssn, phone numbers? (just a best guess, in case you spotted some linking anomalies)

Is the primary key still a number internal to lexis nexis?

How detailed is the social network now? (just people living together and neighbours, or does it includes relatives and family members)

3945496• 8 years ago

Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses?

If they had access to that, wouldn't it be a HIPAA violation?

staticautomatic9• 8 years ago

What do you have from the healthcare part now? Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses because hipaa?

Nothing. The data at issue in this article belongs to a category called "Non-FCRA" (Fair Credit Reporting Act), which means they cannot (really, are not supposed to) be used for things like credit and hiring decisions. Most of the data are from the public domain, although there are some data that are only quasi-public (meaning they're nominally public but you must have special privileges to see them). I haven't seen any truly non-public data.

How is the data linked? ssn, phone numbers? (just a best guess, in case you spotted some linking anomalies) ?Is the primary key still a number internal to lexis nexis?

The primary key is an internal UID, where each person has his/her own. There are edge cases where people in their DB do not have UID's at all or where a single person has multiple UID's.

They obviously have some linking but I've seen little indication that they have a robust graph under the hood. For example, Lexis may "know" that you've cohabitated with a member of the opposite sex about the same age as you for 10 years starting when you were 30, and also "know" that you're married to someone with the same name as the cohabitant, but fail to identify that person as your spouse because the marriage records are siloed in their back end.

How detailed is the social network now? (just people living together and neighbours, or does it includes relatives and family members)

There are lots of data available on your relatives and family members, but again, the linkages are piss-poor. For example, your record may say that your name is "John Smith Jr." and you lived with a man who is 30 years older than you named "John Smith Sr." until you were 18, but fail to identify that person as your father.

3945496• 8 years ago

What kind of bulk data products do they sell?

I'm almost certain they are one of the companies that does the legwork to directly ingest public records information from government sources, but I'm unsure if they sell that bulk data on to other companies.

staticautomatic9• 8 years ago

They have separate divisions for FCRA and non-FCRA data, so which products and data points you have access to depend upon who you are and what you're doing with the data. I believe the data at issue in this article are non-FCRA, which puts it in a category I'd call "enterprise-grade public records search" (as opposed to consumer-facing public records companies like Intelius and Instant Checkmate).

Yes, they are one of the few companies that does the legwork of directly ingesting public records. For example, they buy and resell a lot of data from DMV agencies in states where the DMV is authorized to sell it (Google DPPA for more info). It is otherwise nearly impossible to get these data. I have tried, with the help of the right lawyers, and concluded that the only way to do it would be to sue the DMV.

mindslight5• 8 years ago

What is the pricing model? (eg per request?) Roughly what is that cost?

Is there an "all-you-can-eat" access level that other organizations have?

How granular are the data fields per record (/person) ?

Do requesters generally cache the retrieved data on their own stores, continually re-retrieve it, do analysis in large batches, or what? Would we expect to see big caches of this data sitting around outside of Lexis's vaults?

staticautomatic9• 8 years ago

What is the pricing model? (eg per request?) Roughly what is that cost?

Across all the products I've used (web, batch, API), the price is per-request (where a batch is multiple requests). The actual price can vary by several orders of magnitude depending on what you're requesting. If we're talking about list pricing, it ranges from about 10 cents to tens of dollars per request. There are significant volume discounts available, of course.

Is there an "all-you-can-eat" access level that other organizations have?

I have not seen one myself and I doubt they offer one even to their largest enterprise customers. However, I am fairly certain that they offer it to certain government agencies. For example, I have seen federal government RFP's that require it.

How granular are the data fields per record (/person) ?

It depends on the kind of response/report you're looking at, but as a general matter they are highly granular. For example, provided the data are available, I could itemize a list of every car you've ever owned by make/model/year, infer whether you're in a same-sex relationship, or see what the grounds were for granting your divorce.

Do requesters generally cache the retrieved data on their own stores, continually re-retrieve it, do analysis in large batches, or what?

Aggressive caching is an absolute requirement for API users. That is proximately because Lexis's server does not "remember" your requests. They are logged and have unique transaction ID's but if you run the same search twice they will not check the request against a log cache to see if it's the same as one you ran recently. Instead they'll just charge you a second time (a very easy way to accidentally run up a big bill when running tests against a production endpoint). In combination with the high price per request, you'd be stupid not to cache the whole response.

Would we expect to see big caches of this data sitting around outside of their vaults?

Yeah certainly. You can't arbitrarily run requests and store the data (e.g. in order to resell it), but you can store the results of requests you've made.

tivert• 8 years ago

How granular are the data fields per record (/person) ?

You can see a lot of the data they have on you yourself, by requesting your own report(s):

https://personalreports.lexisnexis.com/access_your_full_file...

I don't think you'll get everything they have on you this way, but I got a printout that included about a dozen individual reports when I made my request.

Cieplak• 8 years ago

Just clicked for me why “healthcare” companies spend so much money on hard discs and data storage.

gascan• 8 years ago

There are surely privacy concerns, but it seems like the evolution of all insurance markets trend towards better risk profiling.

This is a good thing IMO. The point of insurance is to pool risk, not get your high risk subsidized by some sap with low risk. The better insurance companies can profile risk, the more fair the pools.

Then if we want subsidies for high risk individuals, we can work on that separately.

samfisher83• 8 years ago

While its called its called Health Insurance, it should be called health care costs.

The US is the only 1st world country without universal healthcare. The thing is most of us already subsidize the healthcare industry. The hospital has to treat someone in an emergency if they take medicare or medicaid. A lot of times people are using the emergency room as their primary care since they can't afford primary care. The hospital increases the rates it charges everyone else to cover this.

You can use data to predict who is going to be more sick and charge them more. However do you want them to die or suffer. I wouldn't. So why not try to fix the big problem instead of all these little ones about data misuse and just cover everyone since you are paying for them anyway.

chimeracoder20• 8 years ago

The thing is most of us already subsidize the healthcare industry. The hospital has to treat someone in an emergency if they take medicare or medicaid.

The "subsidies" run the other way. Medicare reimbursements do not cover COGS, which means that providers cannot sustain themselves solely on Medicare reimbursement rates; they need to take privately-insured patients (whom they charge dramatically more) in order to stay afloat[0].

These costs get passed on to privately-insured patients in the form of higher premiums.

[0] Medicare acknowledges this, and in fact, Medicare even runs multiple stipend programs to essentially pay extra to hospitals who don't see enough privately-insured patients that they can make up the difference. If they didn't, those hospitals would close, because you can't lose money on a per-patient basis and still run a practice, even if you managed to recruit doctors, nurses, and staff who agreed to work for free as volunteers.

19967• 8 years ago

The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993

I think they just use their point of sales (primary care, etc) to collect data from the client and use it against the client. I know because I used to be in a very similar line of business.

It is easy because clients give you a permanent unique id for payment purposes (ssn), or other unique id (phone numbers) that varies with time (now less with people porting their number). Of course, the point of sale has a list of previous items, even from competitors (medical history) but that has become harder to use, due to laws. Still, most places ask for "emergency contact", which you can use to build a social network. Sick people cluster together. I don't know why, it just happens, and it is a good workaround.

Of course, you need enough data, but it is then a matter of scale (if you have 75% of the market, you have seen everyone in a county at least once) and trade (buy the same data from your competitors).

Personally, due to experience, I prefer to forego insurance and get my healthcare abroad. Better prices than paying deductibles, better services. But I can not recommend that for everyone.

Still this is a dirty business, and I strongly recommend to adopt basic opsec precautions if you get healthcare in the US: never give your ssn, give a phone number that is not used for anything else even better if it is prepaid so not linked to a ssn, never ever give an emergency contact, only list medical conditions that will not cause you legal issues.

3945496• 8 years ago

Personally, due to experienck, I prefer to forego insurance and get my healthcare abroad. Better prices than paying deductibles, better services. But I can not recommend that for everyone.

If you're in the US, that choice could bankrupt you if you ever need major emergency medical care, because of an accident or some condition requiring emergency surgery, like a brain hemorrhage.

https://www.nytimes.com/2017/03/29/magazine/those-indecipher...

19967• 8 years ago

I am lauching my business, I need more money NOW. Healthcare abroads cover everything (eyes, teeth...) and is much cheaper than a deductible even when paying everything cash. And no weird haggling with the insurance or provider to see what is covered, what is not, what is the copay, etc.

This may not cover edge cases, but for most of my personal financial decisions, I follow the example set by governments around the world: I spend in the present without caring too much about future, betting on growth of my resources.

In other words, if I do have a brain hemorrhage, the last of my worries will be bankrupcy.

Why should I bother? If I fail my business, I will be bankrupt anyway.

rhombocombus• 8 years ago

My father went from having a comfortable nest egg to living on social security alone because he was unable to get insurance before the ACA. All it took was a trip to the emergency room and a heart catheterization, followed by another procedure a couple days later and he was penniless.

mkirklions5• 8 years ago

If you're in the US, that choice could bankrupt you

This is literally the point of bankruptcy...

The system is designed to save people who would otherwise be rejected care or put into slavery/debtors prison.

How many safety nets do we need?

jadedhacker• 8 years ago

Whelp, just one more reason why we need Medicare for All. There's no need to enable these people whose business is to find ways to deny people healthcare, just eliminate their industry completely and save money in the process too.

stakhanov4• 8 years ago

There are certain dimensions that it makes a lot of sense to discriminate around: For example, if you're a roofing contractor, I really think you SHOULD be paying higher health insurance rates than I do, as an office worker. You'll just price it into whatever you charge to make roofs, which means the price of a house will start getting closer to what it actually costs the economy. Since I rent, I would otherwise end up subsidizing other people to build or buy houses for themselves, and I don't think that's how an economy should work.

ceejayoz8• 8 years ago

For example, if you're a roofing contractor, I really think you SHOULD be paying higher health insurance rates than I do, as an office worker.

Why? Your sitting eight hours a day is remarkably unhealthy, and roofers (at least where I'm located) are typically separately insured for on-the-job injuries.

stakhanov4• 8 years ago

Don't get unduly bogged down with the example: It works equally well with "horse trainer" or whatever. Clearly some professions have a bearing on your risk profile with regard to certain types of insurance, and there is not always a clear distinction between risks you incur as a private person and risks that your business needs to indemnify you against. -- Like, if you're in a job that involves a lot of travelling and being away from your family for extended periods of time puts you at greater risk of developing mental health conditions etc.

hirundo• 8 years ago

But patient advocates are skeptical health insurers have altruistic designs on people’s personal information.

It's funny that the article felt this needed to be said. Just how would an altruistic insurance company have survived in such a competitive market?

I think I learned the insurance business model early in life. I lived near a horse race track, and used to collect the programs and assemble giant (paper) spreadsheets with various data on horses and their win/loss records. Does the jockey make a big difference? Does the wetness of the track? I would have used any measure that gave me an edge in betting, with zero "altruistic" regard for the horse, its owners, or anyone else but me. You know, like an insurance company.

It turned out that there was a datum that significantly improved my odds, and converted me from a regular loser to an irregular net winner. And it didn't come from a program. I figured out that I could just watch the horses as they paraded to the starting gate, pick the one that I thought looked like it wanted to win, and could, and ran to place a bet on it before the race started. Far from perfect obviously, and I didn't win big, but I started winning more than losing.

I'd bet that insurance companies wish they could do something similar: Have experienced medical underwriters examine and interview potential customers and then make gut level decisions, then judge more by underwriter stats than patient stats.

But that approach seems to be increasingly prohibited, so they make do with what data they can get. It's hard to find that surprising, unless somehow you've confused "insurance" and "altruism" to be related terms.

madengr• 8 years ago

I've been saying this for years. That discount card you use at the grocery store tells your insurance company how much bacon you eat.

3945496• 8 years ago

Has anyone done any research to map out the relationships between the different data brokers? E.g. who has what data to sell, and who's selling what data to who?

staticautomatic9• 8 years ago

I could tell you who is selling what, and a little bit of who is selling what to who, but I don't think any one person has a complete picture.

3945496• 8 years ago

Would it be too much trouble to share what you know? Even just a list of the players would be helpful.

I'd really like to understand more about this industry, but from a consumer perspective, it's very opaque. It's easy to find people search websites (and articles about them), but much harder to understand how they got your data or what else about you may be getting sold.

clumsysmurf• 8 years ago

A recent-ish book that talks a little about this (surprised the article did not mention QuintilesIMS):

"Our Bodies, Our Data: How Companies Make Billions Selling Our Medical Records"

https://www.amazon.com/Our-Bodies-Data-Companies-Billions/dp...

dawhizkid2• 8 years ago

Most people who work for medium or large sized companies in the US are working for companies that are self-insured, meaning your company is taking on all the risk, so if anything your own employer is incentivized to do this and not the insurance company itself.

When I first heard of the Amazon/JP Morgan/BH heathcare initiative my thought on what that company would actually do is surveillance on their collective millions of employees to better predict if they are prone to disease and use predictive analytics to lower their own claims cost.

mtberatwork• 8 years ago

meaning your company is taking on all the risk

While I wouldn't say there aren't any companies out there that are absorbing the entire cost of insurance premiums, most are splitting this in some proportion with the employee.

dawhizkid2• 8 years ago

by risk I mean that the company is liable for all claims cost, but right premiums can come from the employee, employer, or both.

Spooky232• 8 years ago

When I first heard of the Amazon/JP Morgan/BH heathcare initiative my thought on what that company would actually do is surveillance on their collective millions of employees to better predict if they are prone to disease and use predictive analytics to lower their own claims cost.

...or avoid claims in the hiring process.

deegles• 8 years ago

To play devil's advocate, I think data should be used to manage rates for things that a consumer can reasonably change, like diet/exercise. Smokers are already penalized.

e.g. "Our data indicates your average sugar consumption is over Xg per day over the last 6 months. If you commit to reducing this to Yg per day over the next 6 months, your insurance rate will drop by 10%. Otherwise rates will increase by 20% to cover your increased risk for diabetes, heart disease, and stroke."

dsfyu404ed• 8 years ago

That'll end well.

"our data indicates you're probably a women and therefore have an above average risk of having kids, if you commit to gender reassignment surgery your insurance rate will drop by 30%"

Or if that's not allowed they'll just use other things that are a rough proxy for a protected class.

jschwartzi3• 8 years ago

On that note, my insurer helpfully put a note in my file that the doctor should tell me about being more physically active based on my BMI. When I listed everything I do, he turned to his intern and said "this is an example of how BMI doesn't tell the whole story." Then he deleted the note. So it has to be the right data and the doctor needs to be the final arbiter of whether it's meaningful or not.

supertrope10• 8 years ago

The 2010 ACA law considers employee wellness discounts of 30% or more coercive and potentially a way to get around the ban on individual medical underwriting. While monetary incentives are powerful, people are not completely or even close to rational actors. If poor health and prematurely dying (often painfully) aren’t motivators to take care of your health, what will? Health promoting culture like teaching all kids to cook and eat healthier, encouraging fitness through less car centric infrastructure, etc. are needed to address the metabolic syndrome epidemic.

Frequent reminders, small sub-goals, reinforcement, role models are probably more effective than a four figure fine for being unhealthy. Some people can overcome big problems on their own because they are committed, but once you get out into the wider population a lot of marketing, hand-holding, and gimmicks are needed to get everyone to make significant permanent change.

turc1656• 8 years ago

"The companies are tracking your race, education level, TV habits, marital status, net worth. They’re collecting what you post on social media, whether you’re behind on your bills, what you order online."

The only way they can do this and link it to you as an individual is if we have all been lied to about how everything is "anonymized" data being sent between the data brokers and sold to corporations. I've always assumed that the whole narrative about all this data being anonymized was complete and utter bullshit.

Now we know with certainty.

staticautomatic9• 8 years ago

The companies that sell your data non-anonymously to brokers have always (unless they're shady af) said somewhere in their T&C that they will or may do so, and the brokers themselves have never said the data are anonymous (unless you're talking about the ad targeting space).

adrianhel• 8 years ago

Free'ish healthcare is the only way...

jschwartzi3• 8 years ago

Considering how inaccurate some of Fitbit's measurements are( resting heart rate, for example ), I would sue my insurer if I found out they were using that data. My doctor shouldn't be using it either.

RHR is normally measured within the first 30 minutes of waking while lying in bed, which is something Fitbit can determine. What I've noticed is that on days when my RHR that I've measured using their monitor after waking is 54 BPM, they report up to 61 BPM. There's a very long chain on their forum about how inaccurate the measurement is.

brlewis• 8 years ago

I work for Fitbit but am speaking only for myself.

I'm guessing that this is the chain you're referring to since it echoes the "30 minutes after waking while lying in bed" claim: https://community.fitbit.com/t5/Charge-HR/Resting-Heart-Rate...

Other sources I checked did not echo that claim. As one commenter in the chain pointed out, RHR is not minimum HR.

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/G...

https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-...

https://www.health.harvard.edu/blog/resting-heart-rate-can-r...

Also, one of the critics in the chain thinks Fitbit must be inaccurate after his RHR rose from 68 to 71 after "hiking at altitudes up to 14,200 feet" then fell back to 68. I think this criticism stems from a misunderstanding about how altitude affects oxygen levels and how oxygen levels affect heart rate.

All that being said, even if the devices are generally accurate, there are defects and they aren't designed as medical devices. To the extent you voluntarily share your data with a doctor or insurer (which is the only way they'd get your data), your doctor or insurer should treat it the same way they treat other useful but potentially inaccurate information.

jschwartzi3• 8 years ago

Thanks! This is way more informative than any of the responses I've seen from your support team in that chain.

mnm1• 8 years ago

I wouldn't be surprised if people are denied care and left to die due to exorbitant prices based on random, undoubtedly wrong algorithms. Here's where the cost of personal data really becomes huge, at in life or death. Insurers have played god like this since their inception and nothing is going stop them from making more money by shutting out anyone who is a threat to their bottom line. We've only had a law that prevents discrimination on pre-existing conditions for a few years. I'm sure the insurance companies will lobby hard to get rid of it so they can let the very sick suffer and die rather than be forced to pay for their healthcare. This is an end run to that goal in case lobbying to murder people legally fails.

dhimes2• 8 years ago

Exactly why I won't do those genetic-sample tests for "ancestry" or anything else. Eventually, those data will be sold, even if the entire company is sold with it. Eventually, we will be much better at decoding the DNA for predispositions to medical problems like heart disease, diabetes, alzheimers, and so on.

That information will also be used against our kids and maybe our other relatives even if they don't undergo the testing.

supertrope10• 8 years ago

Data is forever. The Genetic Information Non-Discrimination Act could be repealed in the future. Even governments can change.

bawana• 8 years ago

LexisNexis said there is no web page to submit a request for info. I tried their chat option and that person said I had to call. 888.497.0011 After 30 min on hold I spoke to someone. They wanted my personal info including SS# and Drivers license# They saifd they would mail out the info in 10 days.

I guess this 'personal touch' is a security measure.

DenisM• 8 years ago

In WA state to price out insurance all you need to provide is your age, gender, and smoking status. I don't see how insurance companies can use any other information in setting the price?

shiburizu• 8 years ago

As a college student I work taking phone calls for a biz that attends entirely US customer base, my colleague asked why our clients were often leery about sharing things like their photo ID with us, despite being customers with us for many years.

As one of the few who lived in the US amongst us I'd have to say it might have to do with how much companies involved in risk assessment really know about you and how much of it goes to the government -- they have no interest in having us show up in their credit or what have you.

mixmastamyk2• 8 years ago

We desperately need some privacy legislation in the US, years ago.

cutler• 8 years ago

Aren't there obvious GDPR issues with this unless you're limiting the analysis to US insurers?

u801e• 8 years ago

My employer used to provide additional funding in employees' HSAs (Health Savings Accounts) if they participated in a health screening. The health screening involved measuring height, weight, blood sugar, cholesterol and other lipids. There was also a questionnaire about lifestyle choices related to health in terms of how physically active you were, smoking, drinking, etc.

Health Insurers Are Vacuuming Up Details About Customers

Related Stories