You’re not paranoid if…

[firecat]

I got a phone call. The person asked for me by my first name. Then he said he was calling from [$MY HEALTH INSURANCE CO] and they wanted to review my medications.

I said “Why?”

He said because their records suggested [$VITAL SIGN] was [$INAPPROPRIATE RANGE] and my treatment was inadequate. He used that tone of voice that suggests I am expected to comply, if you know what I mean.

I said “I don’t want to” and there was a several second pause and I hung up.

I don’t really think it was a scam, but whatever it was, they went about it all wrong.

Opinions welcome. No advice, please.

Comments

[ex_flameandsong751]

That's the kind of call that is usually made by a doctor's office and not an insurance company, so I suspect it was a scam.

[mrissa]

Yes, just this. Insurance companies will tell you that your treatments are not covered, not that they're inadequate.

[firecat]

I know why they have access and I know why they might have gotten concerned. But it was really the wrong way to get me to cooperate

[stonepicnicking_okapi]

Very weird. You're thoroughly justified in feeling paranoid!

[firecat]

I’m glad to know my spidey sense is working!

[armiphlage]

I'd be reluctant to discuss medications or dosages with anyone other than my own physician or pharmacist. And why would an insurance company have access to vital signs?

[siderea]

In the US insurance companies (and all third-party payers) have 100% access to your medical chart, contractually.

In the US, insurance companies can read the progress notes your psychotherapist writes.

HIPAA entirely supports this. Arguably, it was precisely to facilitate this and remove legal obstacles to doing it that HIPAA was written and passed: it is what the "P" – "Portability" - is in reference to.

[forests_of_fire]

It's definitely shady.

Medicare pushes for patients to get a medication review with a pharmacist once a year to make sure they're taking their medication correctly. IME, that comes from the pharmacy you pick up meds at, though. I imagine that your Medicare part D insurance company could do the medication review, but I personally have always had it from my pharmacy.

The fact that they're talking about vital signs is what makes it shady.

[firecat]

I wish my docs would do drug reviews with me more often, since I’m on a lot of meds and they do interact with each other. But I don’t want to do it like this.

[julian]

I don't know how it would continue on to become more scammy, but it definitely feels as if it *would*, somehow.

[firecat]

Yeah. I was worried they’d ask for more identifying information and try to steal my identity.

[bibliofile]

Yes, definitely weird on multiple levels. Did they ask you to confirm your identity? All healthcare providers verify my identity before discussing stuff with me by phone, no matter who initiates the call.

Seconding everything that everyone else pointed out.

[firecat]

Mine too, in the past. This time, they didn’t. Maybe they would have if I’d consented to be queried about my meds.

[which_chick]

That would definitely creep me right the heck out. Also, not sure my insurance company should be... "monitoring my medical records" aside from paying the insurance claims. Is that their business? Oof. This doesn't pass the sniff test for me.

[firecat]

It stinks even if it actually was the insurance co.

[noelfigart]

My opinion is that your health insurance company is not your health care provider. And if they only went by your first name, it is sketch as hell.

I teach an EMR, so I am coming from the medical provider perspective. My curriculum repeatedly emphasizes two additional verifications of identity. Name, DOB, maybe an address or the last four digits of someone's social. Medical record number if they know it, though few people do.

[firecat]

Yeah, that’s what I expect. Maybe that would have happened if I’d consented to go ahead. Who knows?

[brainwane]

!!!!

[firecat]

IKR?

[the_siobhan]

Honestly I'd expect pretty much anything from an insurance company, but I definitely think you handled it appropriately either way.

[firecat]

Good to know.

[silveradept]

Definitely sus.

[firecat]

I still have a working “this stinks!” reaction!
(I watched both my parents lose theirs. Scary.)

[sraun]

Don't like it, but I can see it happening.

My employer's have had a 'regular check-in with medical professional' program as part my health insurance. There was no way to opt-out in advance - I had to actually speak the person and tell them, 'No, I see my doctors regularly and we are all carefully monitoring my conditions, talking to you is a source of stress I do not need.' to make them stop.

[firecat]

The whole push for employers to get involved in employees’ health care scared the snot out of me. Especially when they tied vital signs in with how much one paid for one’s premiums.

Join this program and you’ll get a discount on your premiums!” > uh, don’t you mean “if you don’t join this program, you’ll be fined”?

“Join this program, and if you meet the weight loss goal we give you, you’ll get a discount!” > nope, you mean “fail to meet our weight loss goal and you’ll be fined.”

They seem to have moved away from such programs, because ample evidence suggests they don’t save companies money.

[nocturnus33]

I think you were cautious. I think if it had been a true call, that phone call wouldn't have been ethical.

[siderea]

No medical ethics adhere to health insurance companies in the US. They are completely free to do this.

Arguably, health insurance companies have no ethics at all; they're supposed to comply with ERISA wrt fiduciary duty, but one of the things people, particularly doctors, have been screaming bloody murder about since the 1980s in the US is that health insurance companies have been effectively practicing medicine without a license, and without any medical ethical oversight or liability to malpractice law.

[siderea]

Uh, I don't mean to map your redactions, but I am pretty sure I know what [$VITAL SIGN] was given what you said happened.

Right now, there's a huge push in healthcare in the US and UK and probably elsewhere to address [$VITAL SIGN], because its considered the primary indicator of [$CONDITION], and [$CONDITION] gets extremely expensive (for the insurance company) if inadequately controlled.

All sorts of horrifying insurance company shenanigans have ensued from this. Mostly, they've pressured the physicians to treat it more aggressively, under the assumption that if [$VITAL SIGN] was too high, it must be because, as the caller implied to you, the physicians were being negligent in prescribing.

That an insurance company decided to jump the rails and just contact the patient directly? I haven't heard of exactly this being done before, but it surprises me not at all.

[siderea]

P.S. more generally, there's a trend in insurance in the US to have special programs to "help" patients do things the insurance company thinks will reduce the insurance company's expenditures.

For instance, my health insurance company just last year rolled out free unlimited online dietician consults for weight loss, and beat the drum a lot for their insureds to sign up. Normally, my insurance plan would require me to get a referral from my PCP to see a dietician (or any other specialist), but not for this. No copays, no deductable, no referral needed, no questions asked.

Edit: but their pet company, under their control. No choosing a dietician for yourself, and good luck if your goal is something other than weight loss. It's just one tiny step removed from the insurance company treating the patients themselves.

Which is a thing, let us not forget: that was the original HMO model: captive pet doctors, doing only what the insurance company wants them to do.

[greghousesgf]

sounds like a scam to me

[firecat]

Based on all the input I’ve gotten, it sounds like something insurance companies do in fact do—which doesn’t change my view that it’s a scam.

[lilacsigil]

I am entirely unqualified to comment because as far as I can tell in the US insurance companies do whatever the fuck they like, but if they try again, refer them to your treating doctor without giving any names?

[firecat]

That’s a good suggestion, thanks!