--I am interested in getting a copy of my personal medical history
report (similar to a credit report), but don't know how to order it. 
If I recall correctly, there is one company in the U.S. that gathers
this data,
which is used by insurance carriers to determine future insurance
eligibilities (life, disability, etc.) and such?
--Do certain types of past diagnoses/procedures as reflected in this
report
(e.g. mild situational non-episodic depression) impact one's ability
to get certain types of insurance in the future (e.g. life, etc.) or
can you expect to pay higher rates?
--Any relevant article links to how one's personal medical report is
compiled and used (or mis-used) would be helpful.

Hello Scholar,

Thanks for your question on confidentiality of patient medical
records. This is a privacy concern to many individuals and something
Congress is hoping to address in the Health Insurance Portability and
Accountability Act (HIPAA). Here is the 2002 press release from Sen.
Tommy Thompson addressing some of the proposed changes.
{http://www.hhs.gov/news/press/2002pres/20020321a.html}
As you see from the last paragraph of the article, most covered
healthcare providers have until April 2003 to comply with the new
regulations.

Undoubtedly, these regulations will pose a paperwork burden on already
beleaguered physicians bogged down in the managed care system. Here's
but I'm sure one of many lawsuits to be filed as a result of these
changes. {http://www.doctorsfirst.com/february2002/groupsues.html} 
It's too bad but privacy, indeed, comes with a price tag.

This white paper from the American Health Information Management
Association describes many of the implications of the use and misuse
of personal health information.
{http://www.ahima.org/infocenter/current/white.paper.html}
Also, if you follow the link to the flowchart "Patient Health
Information Inside and Outside the Healthcare Industry," you'll find a
labyrinth of individuals/entities who have access to your medical
records -- many without your knowledge, I'm sure.

You asked about the specific agency where you could obtain a copy of
your personal medical agency. The name of that organization is the MIB
(no, not the Men in Black); this is the Medical Information Bureau.
{http://www.mib.com}
For $9 you can purchase your medical records file on par with
purchasing a credit report.  Indeed, some of the same entities
compiling those reports are in the medical information gathering
business as well (Equifax, EDS, Experion, etc). I would recommend
searching through the MIB site thoroughly and entering "psychiatric
records" in their search box for additional information.

For record requestion information:
http://www.mib.com/html/request_record.html

Additionally, here is an article from the Journal of American Medicine
entitled, "Confidentiality and Privacy of Electronic Medical Records:
Psychiatrists Explore Risks of the Information Age."
http://jama.ama-assn.org/issues/v285n24/ffull/jmn0627-1.html

As to your question regarding higher premiums charged because of an
individual's preexisting mental health condition, I'd point you to
this article on the Mental Health Patient Rights Amendments (see
caveats in "Key Provisions").
{http://www.illinoispsychiatricsociety.org/MHP-fact-sheet.asp}

"The Mental Health Patients’ Rights Amendment limits the ability of
health plans in the individual insurance market to deny health
coverage to individuals with a preexisting mental health condition. It
also prohibits insurers from charging such individuals higher premiums
based on a preexisiting mental health condition."

I would also offer this additional article as it refers to the
"risk-adjusting" (also known as cherry-picking) done by certain
managed care groups.
http://www.nas.edu/21st/health/health.html

Additional Resources:

The Myth of Patient Confidentiality:
http://www.cisp.org/imp/november_99/11_99gellman-insight.htm

Subcontracting of Health Information by the Government:
http://www.aclu-wi.org/issues/data-privacy/table_1.html

Privacy and Data Protection:
http://ethics.med.miami.edu/bibliography.htm

Reasons for Collecting Medical Records:
http://www.genetichealth.com/Resources_Collecting_Medical_Records.shtml

How Private is My Medical Information:
http://www.privacyrights.org/fs/fs8-med.htm

Privacy "Medical/Psychiatric/Drug Testing" Archive from the Electronic
Frontier Foundation:
http://www2.cddc.vt.edu/eff/pub/Privacy/Medical

Digital Angel:
http://www.digitalangel.net/medical.asp

Verichip:
http://www.adsx.com/prodservpart/verichip.html

For my own family members or anyone with a chronic condition, my only
piece of advice is to be proactive.  If you're hospitalized for any
reason, wait 2-3 weeks from your discharge date and then pay a visit
to your hospital's medical records department. By waiting this amount
of time it will ensure that all your records have been transcribed and
added to your patient record.  Make an official request for your core
chart (admission/discharge summary, lab tests, x-ray reports, etc.) by
signing a Release of Records form.

Many times you can wait for the duplication process (for which some
institutions charge a copy fee), and receive those records at the time
of your visit; otherwise, you will be told when these may be available
to you. This practice is very helpful if you're visiting multiple
doctors/clinics or if you go out of state for your healthcare needs.

I hope I've given you the pros and cons of this issue and answered all
your questions, however, I'll be standing by if I can help or clarify
any of this information.

Search criteria:
personal knowledge

Regards,
V

---

Clarification of Answer by voila-ga on 10 Aug 2002 12:42 PDT

Hello again Scholar,

First, apologies for not having seen your questions sooner.   I will 
do my absolute best to clarify this information, but I hope you will 
consider reposting your question for one of our legal eagles regarding
laws governing disclosure by insurance companies.   I must admit this
is not my métier.

From what I've read thus far on this issue, there does not seem to be
legislation in place for reciprocity of information from an insurance
company -- outside of filing suit against them.   My suggestion would
be to send a certified, return receipt requested letter of inquiry to
your state insurance commissioner {http://www.naic.org/splash.htm}  
Click "consumers," from next page click "CIS" (Consumer Information 
Source).  I would detail the specifics of your situation and let him/
her advise you on what recourse you have.  If you feel your civil 
rights have been violated, I'd urge you to address these with your 
state's attorney general and/or congressional representative. {http://
www.house.gov/}

With regard insurance companies declaring "open season" on
policyholders, I'll attempt to take the personal element out of the
insurability/rating equation.   Insurance companies look at our health
as a shareholder would in assessing a company's stock.  Is this a
robust organization or one riddled with viruses and bad balance
sheets?   How is their ethics portfolio and assets to liability ratio?
 Like shareholders, insurance companies are looking to make a profit
on their share of 'you.'  But as stockholders, many people go to great
lengths to ensure a company is on firm foundation or just to hedge
their investment.  Some even go so far as to risk fines and/or jail
time by resorting to insider trading.

Are insurance companies doing a bit of insider trading with our
medical information?  It seems like a fine line there.  I suppose
everyone must come to their own conclusion on that question.  I did
find this interesting article on GIS technology. 
{http://www.findarticles.com/cf_0/m0EDM/1998_Nov/53366323/p1/article.jhtml}
 
"As GIS data become more readily available, however, and can be more
easily combined with other information, it is easy to see how they can
be misused. Your auto insurance company, for example, could raise your
rates because you live within two miles of a dangerous intersection --
whether you have ever had an accident or not. Eventually, health
insurance companies may cross-reference information about heavily
polluted locations, such as Super Fund Sites, against your past
addresses. They could then charge you more for insurance because they
believe that where you lived as a child puts you at greater risk for
cancer."

As far as companies forcing individuals to authorize release of
information outside of their MIB file, people have gotten quite
creative in this regard.  Check out this gentleman's advice from this
website. {http://www.martylyons.com.Privacy.html}
 
"As most insurance companies use your Social Security number to track
your medical information, a request can now be sent to the Medical 
Information Bureau, which tracks health data on 15 million Americans,
for a copy of your file. Once that is obtained, they can now write 
letters in your name (with signature, see below) to each hospital, to
get complete copies of your entire medical history. When opening 
insurance accounts, remember you are NOT required to supply your 
Social Security number -- simply write on the application "not 
required by law" across that area on the form, followed by "assign 
unique number"; I have never been denied insurance by doing this, and
have always been assigned a unique number by the provider."

Another way medical records can be obtained, which I failed to address
in my initial answer, is through a subpoena.  If you are involved in a
court case of any kind, your medical and/or psychiatric records may be
brought before the court.  This would also be something you might 
address in your letter to your state officials so that may better 
guide you.

My advice would be to read any "blanket authorizations" very carefully
and know what you're signed.  These notices are usually in microprint
so carry a pocket magnifying glass at all times.  Rather than signing
one of these blanket documents, I would ask if there is a limited or
edited waiver you may sign instead. 
http://www.bullybusters.org/home/twd/bb/legal/
(archived under "medpriv" and "cyberpriv")  Many people authorize
these documents without really knowing the ramifications or options
before signing so I'm glad you've asked this question.

Scholar, outside of paying in cash/out of pocket for all your medical
care and
prescriptions, I do not see any way *not* to leave a paper trail of
our medical history.  It is indeed a dilemma for many and I hope that
the HIPAA regulations are a step in the right direction and not the
devil in disguise.  We shall see, won't we.

National Center for Policy Analysis:
http://www.ncpa.org/ 

Institute for Health Freedom:
http://forhealthfreedom.org/Publications/Privacy/

Recommendations from AARP:
http://www.aarp.org/bulletin/mar00/privacy.html

Excerpt from "Database Nation" by Simson Garfinkel:
http://commons.somewhere.com/rre/2000/RRE.Database.Nation.html 

National Workrights Institute: (some scary stuff
here)http://www.workrights.org/issue_medical/mp_legislative_brief.html

Gee, Scholar, I hope I haven't muddied the waters or given you too
much to digest with this extra information, but your specific
questions made me look at this issue from many different aspects. 
Again, thank you for joining us at Google Answers and please feel free
to post a legal question to our experts.

Google search words: 
medical history+blanket authorization
medical history+misused
consumer rights+medical information+disputes
medical information+disputes
collecting medical information
patient bill of rights+medical information
privacy+personal medical information
state insurance commissioners
federal government+state representative

Best wishes,
V

---

Clarification of Answer by voila-ga on 12 Aug 2002 19:22 PDT

Scholar,

Quoting from the Disabilities Discrimination Act of 1996 with
specifics to your quesion about higher premiums:  
{http://www.mindout.net/iwi/id5-law.asp}

"The Act also makes it illegal to provide goods, facilities and
services to a disabled person on terms which are different from those
given to other people. For instance, it requires insurers to
demonstrate higher risk (such as reduced life expectancy) as a direct
result of a specific psychiatric condition before they refuse cover or
increase premiums."

National Institute of Mental Health:
http://www.nami.org/index.html

correction to link mentioned above:
http://www.martylyons.com/Privacy.html

Great job!  I appreciate the thoroughness.

Could you clarify two thing:  is it open season for an insurance
company to use whatever information they find in your MIB file to deny
coverage or increase rates?  Is this regulated (by laws) and must they
disclose their methodology for assisgning a rate, denying coverage,
etc.

FYI:  I believe that most people do not have MIB files (i.e no
information stored b/c it was never submitted to MIB).  How do the
insurance companies compensate for this lack of outside information on
most of their policy holders?
On a separate note, will they make you sign a statement when you apply
for insurance that authorizes them to go beyond your MIB file and
search hospital and doctor's records, for instance?  If yes, do they
typically do this?