Question about health insurance from a Canadian

[hannamaren]

There is a commercial on a US channel about a private health insurance company. It shows people that forget the meds theyre on, the allergies they have, etc. then it says "at Kaiser we save all that information for you so you dont have to worry"

So my Q. Does your insurer know all that? (allergies, complete medical history since you started with them) and can your doctor access that info with your insurance card? Through the computer or do they have to call the insurance company?

When you switch insurers, does the info transfer? Can it? If not, where does it go?

[lilibet]

I work for an insurance company - we don't keep medical records. We don't have records on allergies or anything like that. Our site is able to gather all the diagnosis codes that have been billed on claims for X number of months and compile that into a little chart and apparently doctors can get access to that (we can't see that as employees helping members). The only info we have is what is billed on a claim. Prescriptions are handled in a different area so I'm not sure what all they know.

[changedname]

I'm canadian too so take it with a pinch of salt but I used to live in California right next to a Kaiser Permanente hospital. I always thought that Kaiser specifically is different because they have their own hospitals that people who have their insurance go to? Therefore they would know the person's meds etc? It's all in one network? I'm probably completely wrong.

[thelongroad]

My insurance company sees at some point what we are up to when they pay the bills. To my knowledge they don't store it for medical purposes. My doctor, or myself, can't call them for any of my medical related info.

The info does not transfer when you switch, but you do have to disclose pure existing conditions yourself...not for long.

[boiler717]

Kaiser knows all that info because it is an HMO. All of your care if being provided by the Kaiser system so they are all linked. Your insurer won't necessarily know all of that info but they can build a profile based on your medication claims history and ICD codes used by your medical visit.

[hannamaren]

It just seems like such a great idea. And one pro to the insurance company situation. But if it is just one company, then boo.

[Pilsy]

Through the insurer I had last spring, I used a mail-order prescription service that allowed me to fill out a profile that included this information. I had to populate it, though. Can't way it was terribly helpful, though I guess it would be if I had a laundry list of allergies and prescriptions.

That is, of course, very different from a complete medical history. To the best of my knowledge, no, my insurer does not have access to my complete history. Naturally, they can piece together some information based on what's being billed while I'm covered by them, but in a month, I'll be on my fourth insurer in 12 months. I suppose that one won't know much about me.

I'm not sure what my doctor can access from the insurer. Good question. I don't think they can, or at least not without doing something shady.

[milkrations]

Oct 11, 2012 19:08:41 GMT -5 hannamaren said:

It just seems like such a great idea. And one pro to the insurance company situation. But if it is just one company, then boo.

Like pp's have stated, Kaiser is both an insurance company and an HMO. If you belong to Kaiser, you have to use their facilities, and all their facilities are linked. So, any Kaiser facility can pull up your info from your history at all Kaiser facilities.

Other HMOs have this too, but not health insurance companies. My current doctor and medical facility is part of a large regional network. I could go to any facility in that network and that facility would be able to pull up my health history. My insurance company has nothing to do with this sharing.

It is not so much an insurance thing as a health network thing.

[Deleted]

Isn't Ontario working on electronic health records? Or was that somewhere in the Maritimes? The general idea is definitely being implemented in parts of Canada.

[ellipses84]

Kaiser is an HMO and you have to use their clinics, hospitals, pharmacy, specialists, etc. (although they do make agreements with others if theirs are too far away). They manage patient info. online, so by the time you get home from an appt, info. about your appt. and prescriptions will be posted online. Lab results are posted when they are done. Specialists have access to medical history from Kaiser.

I've been on many HMO's and some are horrible. Kaiser is the best by far, in my experience. During my 20's I was having to switch health insurance almost annually because my work would try to get cheaper rates or I switched jobs. You typically have to fill out forms, sometimes at both Drs., to get medical records transferred and I didn't always bother. I wish my current Dr. had all my medical records. Otherwise they just rely on patient history, from memory, which isn't that good.

I actually think Kaiser is similar to Canadian healthcare, if only the whole U.S was on Kaiser, then I could get care anywhere

[Deleted]

Kaiser is one insurance co. Yes, my dr can pull up all the meds I'm on, I can email my dr, I get test results online.
No, the information does not transfer to another insurance co.

[isabel]

HMOs are a pain in the ass compared to PPOs because you are required to use that company's facilities and usually can't see a specialist until you are referred to one by a primary care doctor. As I understand it, Kaiser is pretty good for an HMO.

PPOs let you go to anyone in network, which is pretty much every other doctor, and you can choose to see a specialist over going to a primary care doctor to begin with. It's a much better system in my opinion. Though they don't have access to your medical records that way. You have to have them transferred from doctor to doctor if you want the newest one to have access to the information.

[rubytue]

I have a PPO (BCBS), and they have information on some of my conditions. I logged onto their site the other day and freaked out with what was on there. My gallbladder in 2009, for example, was on there. There was another code in there for "non-dependent drug abuse," which pisses me off bc I don't know what it means nor can I get it removed. And now I'm listed as steroid dependent. Its probably not as bad as it feels in my head, bc technically it's true (for the next few months). But I don't like seeing it.

[hannamaren]

Oct 11, 2012 21:32:46 GMT -5 @tokenhoser said:

Isn't Ontario working on electronic health records? Or was that somewhere in the Maritimes? The general idea is definitely being implemented in parts of Canada.

They have been working on it for years and years. I think it is closer in BC or maybe the maritimes. Right now, you can see all the doctor visits of your patient when you run their health card, but not the details, drugs, allergies, etc.

[jaylea]

You would be amazed what health insurers know about you. Any claim, or combo of claims (whether it be a billing code, prescription, treatment, etc) can be used to identify your likelihood of having certain conditions, whether you're overweight, a smoker, etc. Even though they don't have access to your medical records. It's wild.

[hannamaren]

Oct 12, 2012 8:41:00 GMT -5 jaylea said:

You would be amazed what health insurers know about you. Any claim, or combo of claims (whether it be a billing code, prescription, treatment, etc) can be used to identify your likelihood of having certain conditions, whether you're overweight, a smoker, etc. Even though they don't have access to your medical records. It's wild.

I assume the insurer knows lots. I just wanted to know if it was shareable with your doctors who need the information to help you not charge you.

[jaylea]

Oct 12, 2012 8:43:59 GMT -5 hannamaren said:

Oct 12, 2012 8:41:00 GMT -5 jaylea said:

You would be amazed what health insurers know about you. Any claim, or combo of claims (whether it be a billing code, prescription, treatment, etc) can be used to identify your likelihood of having certain conditions, whether you're overweight, a smoker, etc. Even though they don't have access to your medical records. It's wild.

I assume the insurer knows lots. I just wanted to know if it was shareable with your doctors who need the information to help you not charge you.

Nope, thus the need for EMRs. I suppose they could share it with your physician, if you brought the conversation together. But logistically, that's very unlikely to happen. A physician would have more medical info than an insurer anyway - insurer's only need to know about the billing side.

[ESF]

Kaiser is amazing. I don't have to think about anything. It is so nice to have one website to log in and get lab results, make doctor appointments, and see my plan benefits. I live near their headquarters, so I've got it great. There's one huge complex extremely close to my house where all my doctors appointments are held. Today I am going there to pick up both eyeglasses and a prescription from my dermatologist.

Definitely not the case with any other insurance company I've ever had.

Most people will say that the US health care system should be modeled after Kaiser.

Per my friends, they are also an amazing company to work for as well.

[knitty]

Yes, the insurer sees everything you tell your doctor. They even go so far as to cover certain drugs or procedures for one diagnosis, but not for another. It's creepy as hell.

(For the Americans: socialised health care could care less what your private medical info says. They pay for the doctor's time or for equipment or procedures or drugs, so long as the doctor certifies it's medically necessary (ie, not cosmetic unless the cosmetic issue is causing distress))

In Australia we've had electronic medical records for many years, but it's not given to Medicare or a private insurer, it's private.