Insurance Agent Forum

[schealthagent]

Somarco mentioned this in another thread and I feel it deserves it's own. This is an amazing tool (for underwriters) and I just found out about it last week. I had an applicant declined for "reasons not disclosed in the application." Upon speaking with him he started rattling off rx's he had taken in the past that the underwriter had asked him about.

How do they gather the information? Who reports to them? Can you get a copy of your file like with the MIB (I have been emailing their website to try and figure this out and will post anything I find)?

On one hand this seems like a great way to identify and control risk, but I can see it being a night mare in underwriting especially when you have doctors who are more eager to write a prescription than to find a cure. Thus stamping their patients with a scarlet letter.

The only company I have run into this with here is Carolina Care Plan (a Medical Mutual of Ohio Company.)

[CT Insure Guy]

I am pretty sure Connecticare uses it here in CT and it has shaken some clients who chose to leave off some of their past meds. Connecticare just tells us "We have access to a database of prior RX use" so I am sure this is what you are referring to. It's no surprise that they are harder to get approved thru than any other carrier here in this state.

[somarco]

To my knowledge, Intelliscripts is only available to carriers by subscription. I don't know that individuals can access their file like they can with MIB.

Milliman gathers their data from PBM's. Every time a script is filled it is processed through a PBM who in turn sells the data to Milliman who sell it to carriers.

I had a lady last yr turned down by Aetna. She had purchased a Copay Saver from GR which of course has no Rx benefit. I convinced her to pay a bit more (surprisingly not that much) and apply with Aetna.

She told me she only took one med . . . Synthroid.

Aetna rejected her.

When I called, all they would say is there are more meds she has not owned up to.

Back to the lady. Seems she had a very rich copay plan and a doc who liked to write scripts. After some prodding she came up with 4 or 5 more scripts, all one time deals (sore throat, sprained ankle, etc.)

Sent the app up again only to have it rejected one more time.

Called Aetna.

Seems she had been prescribed 17 different meds in the prior 2 yrs.

Not all carriers use Intelliscripts (and apparently GR is not one of them). I do know that Aetna and Humana use them. Could be more.

[schealthagent]

I finally got in touch with someone at intelli script friday. It seems that may carriers subscribe - but since they pay per report it is a card that they hold in their sleeve. For instance, BCBS of SC subscribes but I have yet to have a new applicant's "file pulled." Maybe they wait until a claim is submitted sometimes? OR, it might be more of a group underwriting tool. In any case, what happens is Intelliscript doesn't do anything as far as compiling data until they have a request from a carrier, they then retrieve the data from their sources to form a report, which is sold to the carrier. I am ignorant of a lot of things but can't believe I didn't know about this before.

[somarco]

I doubt it is used for group underwriting, unless small group.

Milliman is the major source in the US for medical related actuarial data. Most, if not all, carriers use Milliman's reports & studies for setting their rates and underwriting loads (group and individual).

Unless you have been involved at the carrier or reinsurance level there is no reason for you to know about Milliman (formerly Milliman & Robertson).

They also provide pay grade and salary data to the HR industry.

Some carriers do engage in post-issue underwriting. Post-claim underwriting is prohibited in many jurisdictions and is a hot topic, particularly in rescissions.

[schealthagent]

Somarco, thanks for the useful input.

[emptyeternity]

You CAN get your own MIB, i sent away for mine and it came back clean. They allow you one free report per person per year, its like a medical credit score.

[SunDevil]

Found the following on privacyrights web site; Hope this helps.

Until recently, use of prescription drug databases was unknown to consumers. Insurers' use of these databases first came to light in 2007 when the Federal Trade Commission (FTC) sued Milliman, the owner of the IntelliScript database, and Ingenix, Inc., owner of the MedPoint database.

The FTC claimed that the companies are consumer reporting agencies subject to the FCRA. Milliman and Ingenix agreed to follow the FCRA

Individuals who have applied for individual health, life or disability insurance may also request a copy of any prescription report directly from MedPoint or IntelliScript. Reports are available once a year whether or not there has been an adverse decision by an insurance company.

You can request a copy of your MedPoint report by calling (888) 206-0335 or writing to: MedPoint Compliance, Ingenix, Inc., 2525 Lake Park Blvd, West Valley City Utah 84120. Additional contact information can be found at www.ingenix.com/ContactUs/

IntelliScript reports are available by calling the toll-free request line at (877) 211-4816. Consumers will have to provide their full name, date of birth, last four digits of their Social Security number and current zip code. Milliman will provide a copy of any information the company has on an individual as well as the names of insurance companies that have requested a prescription history. The company's Web site includes information about the product as well as additional contact information. www.rxhistories.com/how_it_works.html
Privacy Rights Clearinghouse--privacyrights.org