Psychiatrists and their patients should know that the “blanket authorizations” signed by insurance company beneficiaries for release of medical information may include release of sensitive prescription drug use history.
And there is evidence that such information can be “data mined” for use in insurance underwriting.
APA member Charles Portney, M.D., of Los Angeles, alerted Psychiatric News to the case of a patient who came to him seeking treatment but who was especially concerned about confidentiality. “He was a health care professional himself, and he was concerned about psychiatric care impacting his career,” Portney told Psychiatric News. “I assured him of the confidentiality of his treatment with me. I don’t have an electronic medical record, and I told him that pharmacies can’t release information without a signed release.”
Two months later, a life insurer contacted Portney with a request for the patient’s entire medical file. The patient had applied for life insurance before beginning treatment and had signed an authorization for release of medical information; when Portney informed the patient of the request, the patient did some investigating and discovered that the insurer was contracted with a company called ScriptCheck—which is a subsidiary of Quest Diagnostics—that mines prescription data so that life insurers can use the information in underwriting.
Portney was shocked at the level of intrusion and told Psychiatric News that psychiatrists and their patients need to know that the authorizations signed by patients in insurance contracts—which are often signed with little scrutiny and are not always specific about the kinds of information that may be affected—significantly alter what psychiatrists should tell their patients about the confidentiality of their treatment.
“My colleagues and the public need to look at these blanket releases, and we need to inform patients about what they may cover,” he said. “And we have to alter what we are saying to patients when we reassure them about confidentiality.”
A spokesperson for Quest Diagnostics, when contacted by Psychiatric News, issued the following statement: “Before issuing a policy, life insurance companies receive written authorization from applicants to access and use medical information including prescription histories as part of the underwriting process.
“ExamOne, a Quest Diagnostic company, offers its ScriptCheck service through a third-party vendor that sends existing prescription data from pharmacy records to life insurance companies for use in their underwriting processes. The production of these prescription records is based on the life insurance applicant’s completion of an authorization that directs health care providers, including pharmacy benefits managers, to send their health information to the life insurance carrier.”
Portney also told his story to the Los Angeles Times, which published an article October 21 under the headline, “Your Prescription History Is Their Business,” and a line that read “A secretive, for-profit service called ScriptCheck keeps track of all your prescriptions, even those you pay for with cash. Life insurers pay for the data.”
In that article, Times consumer reporter David Lazarus wrote that “48 states, including California, maintain databases that monitor people’s prescription-drug use, although access to this information is generally limited to doctors, pharmacists, and government officials.”
Lazarus quoted one insurance company representative as saying, “From the consumer’s perspective, you may want to keep certain things under wraps. But when you buy a policy, an insurer will want to pull all information about you.”
Steven Daviss, M.D., chair of the APA Committee on Electronic Health Records, told Psychiatric News that health information exchanges (HIEs), which connect different sources of patient health care data for the use of practitioners caring for patients, can also be an unexpected source of sensitive information. In Maryland, for example, the HIE contains information on hospital treatments, laboratory and radiology data, diagnoses, and medications. “This is valuable information that improves the continuity of care, but states have different policies regarding access to these data beyond treatment purposes,” he said. “Most states have mechanisms that allow one to opt out of the HIE and to see who has accessed your information.”
Portney wonders what other information might be accessed and how it will affect medical and psychiatric treatment. “Are there also databases of lab tests performed, hospital stays with diagnosis, medical billing, that will be the next information accessed by some commercial entity that is similar to ScriptCheck? Will this change the psychology and expectations of privacy and disclosure in medical treatment, particularly psychiatric treatment? And will this result in patients being more hesitant or resistant to getting prescriptions filled or actually taking the medications?” ■