[Video at http://services.brightcove.com/services/viewer/federated_f8/1418520436 is no longer available]

A week ago Ted Eytan posted about a Consumer Reports Health blog post, including a video of a patient who is unable to get health insurance because of an error in her MIB – her Medical Information Bureau record, very much like your credit bureau record. As a direct result of the error, she’s exhausted the last bit of her 401(k) and expresses concern about not maxing out her credit cards. (And she still doesn’t have insurance.)

A healthy discussion ensued in the comments there, ending with my deciding to phone the MIB and get my once-a-year free copy of my record. It arrived today, and it’s eye-opening – not because of errors per se, but because of the nasty little details between the lines.

As it happens, I got a glimpse into that system just as the doors closed. Given the opacity of the system, I shudder to think about my chances of correcting any error. Here’s what happened.

My comment tonight on Dr. Ted’s blog begins, “Well well WELLLLLLLL, looky what we have here: it’s e-patient Dave’s very own MIB response! Delivered in a right timely fashion – requested on 8/27, mailed on 8/29, received today.” It continues:

The reality is interesting. It contains two (just two) medical history items. I hereby disclose all to the universe, foregoing all rights to ever get this toothpaste back in the e-tube:

1. 9/21/01: Blood pressure, significant to health or longevity. Currently under treatment. Information obtained from licensed physicians or medical practitioners, hospitals, clinics, or other medical or medically related facilities. Within 3-5 years prior to application.

FASCinating! So, sometime 1996-1998, somebody reported me with high blood pressure, and said I’m under treatment. Bingo. I do confess it; mild hypertension in the late 1990s.

But the letter assures us of their decency – the only thing in the letter that’s in boldface: The above report from XYZ Life will be deleted on 9/22/08 as all reports more than seven years old are eliminated from our files.

So if I’d waited just four more weeks, I’d never have seen the item, nor would any further inquirer. Indeed, it’ll be expunged from my record forever, less than three weeks from now. That’s nice, considering it’s 10-12 years since the original report.

But wait – there’s more! The second item in the report, from ZYX Life, is dated 11/13/06 and is identical, except for the ending:

Blood pressure, significant to health or longevity… At some indefinite time in the past.

Booyea! The party of the second part quotes the party of the first part! No further data, but the record (nee 1996-98) lives on, rebranded as “sometime in the past”! And it too will expire in 7 years: 2013, a mere 15-17 years since the report it’s talking about.

But wait again, you say; how do we know the second was quoting the first? Well, later in the letter is a required disclosure of every inquiry there’s ever been on my record (similar to credit inquiries), and guess who inquired on 9/1/06? That second company, which apparently then posted *back* into the report in November, giving my record a new life (so to speak).

Did I say “disclosure of every inquiry there’s ever been”? How silly of me – the *information* stays for 7 years (and can evidently be “renewed”), but inquiries are erased after just two years. Beyond that, apparently, it’s none of your business who wanted to know – which, as we’ve seen, can be the answer to how the info got there.

Now do the math: ZYX made that inquiry on 9/1/06, and my letter was printed on 8/29/08, the very last business day before that inquiry was due to be erased (9/1/08). If I’d been a day later, that little paper trail of “who was quoting what” would have been gone forever.

And did I say “every inquiry”? Actually,

The identity of the inquiring member company is not disclosed when [it’s an] MIB member company.

Well, at least their confidentiality is ensured.

Since I’m in the empowerment business, to me the central issue is that there’s a total imbalance of power here. I understand that insurance companies are at risk from fraud, hence the MIB, but we (e.g. Sheila in that video) are very much at risk from errors, and according to the letter, accuracy of the records is not the responsibility of the MIB.

The original information on which the reports were based is in the possession of the reporting company. If this does not provide sufficient information for your purposes, please contact the Medical Director of the company that reported the information.

And good luck!

As they say, sunlight is the best disinfectant. So I want to know:

• Is anybody, anywhere responsible for the accuracy of your MIB record?
• Is anybody liable for the consequences of reckless or negligent errors, or even for simple errors?
• Is anybody required, under penalty of law, to correct such errors and make restitution for benefits that were wrongly withheld due to the errors?

This isn’t a merely academic matter. As one commenter said on the original Consumer Reports post,

Our family alone has had to “fight” our insurance company 3 times in the past 2 years due to coding errors. It truly is a nightmare, especially since it often takes weeks or months to get the correct code recognized and by that time the insurance company likes to say “coverage denied – not submitted in a timely manner”.

Patient empowerment isn’t just about patients gaining power in medical knowledge. Ultimately it will be about patients regaining control of the entire transaction.

I don’t mind if somebody keeps records. They just darn well better be accurate, and they better be open for inspection, and there better be a mechanism for making it right. I want to know:

• Who’s accountable for accuracy?
• Who’s responsible for consequences of errors?
• Has the doctor been asked to make a correction? (I asked on the CR blog and I don’t have an answer yet.)
• Why hasn’t this woman’s problem been resolved?

Mistakes do happen. My own hospital’s 2003 x-ray identified me as a 53 year old woman. What’s in *your* MIB record? Call ’em up and find out – it’s free every year. It’s a 4 minute robot interview plus 3 minutes of robot intro.

Who knows what source info is about to expire from your file?