My family and I have “good” insurance. Oh, sure, I’ve spent dozens of hours fighting our insurer to reimburse us for life-saving cancer drugs that my husband had the temerity to need while he was in Germany, where those drugs cost somewhere between a tenth and half the price that they would have been in the U.S. They didn’t come with the exact same package size or dosage as is standard in the U.S., and so our insurer initially rejected some thousands of dollars in claims. Never mind that my husband saved them some tens of thousands by becoming critically ill while in Germany instead of Ohio. I contested those denials and won most of them. That’s what it means to have “good” insurance.
But yesterday, I just about blew my top on account of the latest hassle from our “good” insurance. On July 1, our employer switched to a new prescription mail plan, Express Scripts. That meant all of us employees needed to set up a login on this mail-order pharmacy’s website. I tried to enter my info, and the screen kept kicking out my email address. I tried setting up a login for my husband – easy peasy. But I couldn’t set up a login for myself.
After about an hour of wrestling with the website and talking with condescending phone reps “patient advocates” – I’ll spare you the tedious details – a supervisor finally informed me that their system wasn’t malfunctioning. Instead, the problem was that my employer hadn’t contracted for dependents to have access to their own prescription information. All my prescription management has to be done through my husband’s ID. All prescription reminders have to go to a single email address; it’s impossible for each partners to get a reminder sent to his or her individual email account.
How is this fucked up? Let me count the ways!
First, this has got to be in violation of HIPAA privacy rights. The Express Scripts supervisor told me that it’s HIPAA compliant. I don’t see how that can be squared with two basic premises of HIPAA: 1) no one but me has the right to access my medical records unless I waive that right, and 2) I have the right to access my own own medical records!
Second, this is just sucky customer service. “Express Scripts” is a wonderfully ironic name. I spend a good two hours dealing with this problem yesterday. (Add another hour for time spent calling physicians offices for old prescriptions that hadn’t transferred and complaining to HR that my kids weren’t on the plan at all).
Third, denying access to dependents decreases efficiency of service and drives up costs for Express Scripts, which will surely be passed along to subscribers. They supposedly want patients to use the website, judging from the message on autoloop played after you’ve dialed customer service and are put on endless hold. But in fact the only way I could access my information yesterday was through talking with a real (and rather snotty) person, who first implied that I must be doing something wrong if I couldn’t sign up for a login.
Fourth, given that the website is the only place where a patient can view her prescription records, lack of access could be medically dangerous. If you’re on multiple medications, they can be hard to keep track of. Plenty of illnesses, from HIV infection to mental health problems, can be exacerbated if you miss a dose.
Fifth, this system is absolutely infantilizing for the “dependent.” I’m 45 years old; I want to be able to manage my own health problems without always having to ask my spouse to do me the favor of forwarding emails, etc. Obviously I know his login and password – I set it up for him, after all, with his permission – but lacking access to one’s own record is structurally and symbolically infantilizing, nonetheless.
Sixth, this system is almost guaranteed to produce sexist effects. My employer’s policy says that when both partners work for the university, premiums for family coverage will be charged on the higher-paid employee. Since the university is the biggest dog in town, quite a few couples are in this position. I’d be very surprised indeed if women don’t make up a strong majority of “dependents” who are also employees in their own right.
And finally, for couples where one partner is controlling or abusive, denying the “dependent” partner access to their own records could subject her (or him) to further abuse. Obviously marriages where one partner tried to control the other through access to needed medications have much, much deeper problems. However, it’s because such marriages (unfortunately) exist that HIPAA privacy protections extend into the family.
Of course I called HR about this. Express Scripts told me that they do offer plans where dependents can access their information. Ohio University could have chosen to include this in their contract with Express Scripts. I asked HR why they didn’t do it. HR will “get back to” me. (Ha.) While I’m waiting for a response, I have plenty of time to ponder how this is just one of many, many ways in which our current system fails to deliver humane, rational, and efficient care and may be driving the need for blood-pressure meds and anxiolytics.
I don’t know if the now-endangered public option will be a panacea. It has the potential to fail, economically and politically, if private insurers are allowed to cherry-pick the lower-risk customers. But abandoning the public option would be even worse, for reasons Robert Reich outlines:
Without a public, Medicare-like option, health care reform is a bandaid for a system in critical condition. There’s no way to push private insurers to become more efficient and provide better value to Americans without being forced to compete with a public option. And there’s no way to get overall health-care costs down without a public option that has the authority and scale to negotiate lower costs with pharmaceutical companies, doctors, hospitals, and other providers — thereby opening the way for private insurers to do the same.
(The rest is here. Have I mentioned lately that I adore Reich?)
Yup. Isn’t it ironic that it’s now us liberals who are trying to introduce some real competition to outfits like Express Scripts? And that it’s the conservatives who are terrified of a little competition and cost control?
Update, 8/19/09, 12:30 p.m.: Late this morning I had a good conversation with the HIPAA privacy “team leader” for my region. He impressed me with his thoroughness and professionalism; it was worth waiting for a callback, and far preferable to speaking with an unknowledgeable phone rep. He had to be circumspect because he can’t prejudge a situation, but he basically agreed that there are two potential issues here: the dependent’s lack of access, and the primary policyholder’s access to an adult dependent’s information. The first is not a HIPAA issue if my employer’s notice of privacy practices specifies that we must ask for our personal health information in writing – which my employer indeed does – except that there may still be an issue of discrimination if dependents are treated differently than their insured spouse. On the second point, Ohio University’s privacy notice says: “Unless authorized by you in writing, your health information: (1) may not be disclosed by the Plan to any other University employee or department …” My husband is a university employee, so OU would seem to be violating its own policy on this score.
In short, if anyone is in violation of HIPAA privacy provisions, it’s Ohio University, not Express Scripts (which is guilty only of poor customer service). I’m still waiting to hear back from HR. If I don’t, or if I get an unsatisfactory, I have enough information to lodge a formal complaint. To those critics who complain that the government can’t do anything right and therefore can’t be entrusted with health care: My experience this morning shows that this needn’t be the case.