Read up here if you have not heard of the MIB, and you might just find you have a file, that is if you have been to a physician and had insurance cover the visits or any other health issues.

This is an exchange between all insurance companies with a data base where they can all exchange notes, so if company A declines you for coverage, chances are the information contained in the file will also do the same for you with company B and C and so on, unless the  decision process it outside of what is normally reviewed for past health care records.

This a nice data base for the insurers, but what happens when an error is created somehow, will all those same companies have the SAME information, so it's a domino effect.  There are more than 470 insurance companies that subscribe and provide data, now that's a lot, do we have more companies in the US than that?  Watch the video.  Even after all her efforts with getting a correction made, she is still coded with COPD and not asthma, so it looks like there is no win to this error, so who's going to fix things when they break.  Again the insurance business doesn't make money folks who require more than a normal check up so what gives.  Check out the MIB in the meantime if you have had issues, so even if you can't get it fixed, you might get an answer if you feel you have been denied coverage due to any errors with information provided. 

In a related article US News and World reports on the same subject.  Why to insurance companies cover cancer drugs given in the office, but yet will refuse those in a pill form that one takes at home?  BD

"The problem is bound to grow as insurers make use of sophisticated data tools dubbed "denial engines," which are touted to reduce reimbursements by 3 to 10 percent. Bearing brand names like Ingenix Detection Software and Bloodhound Technologies' ClaimsGuard, they search patient records for any signs that claims have strayed outside company parameters. Weeding out fraud or speeding up processing is one thing; serving up excuses to deny legitimate coverage is another."

With all manner of high costs, limited protections, and confusing fine print, it’s tough going it alone in the health-insurance market. It’s all the more intimidating for those whose health history is being quietly tracked by a little-known insurance-industry group called MIB.

"Sheila eventually traced the problem to a coding disparity at her doctor's office. She says letters and phone calls to both her doctor and MIB have been to no avail, and the problem remains uncorrected on her record, effectively blocking her from obtaining individual health coverage."

Cover America: Denied insurance because of a medical coding error: Consumer Reports Health Blog


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