Benefits with strings attached

Benefits on paper may look good, but the reality can be a very different picture. Should you decide to use them, they can, and likely will, be used against you. A patient was applying to take medical leave disability through his insurance plan at work and needed his doctor’s statement, when Dr. Westby G. Fisher, MD, FACC decided to read the attached paperwork. He discovered that in order to use his disability benefits, his patient had to sign away all privacy rights to his personal and medical information. The most intimate personal information will be made available to anyone.

Dr. Wes’ article is must reading. As he noted: “This patient's healthcare record will be ‘free and clear’ from a HIPAA perspective if this patient signs this ‘Medical Disclosure Authorization.’ Everything and anything about their health is fair game... forever. Both this patient’s employer and future insurers can use this information against this patient for any future claims (even if their health problem is resolved). Yet if this patient does not sign this form, then this patient will not likely receive the benefits for which this patient has paid for through deductions from their salary.”

But there is more to this story.

This employer has outsourced the management of its disability, medical leave, and workman’s comp benefits to Reed Group, an international company based in Westminster, Colorado with partners in Asia Pacific and the UK and Ireland. There are numerous companies like this that contract with insurers and employer groups. As its mission statement explains:

Presley Reed, MD founded the company in 1981 to address absenteeism and productivity issues in the workplace. Reed Group is an industry leader in developing tools and services to assist employers, claims administrative services, case management companies, insurance carriers, government agencies and third-party administrators with managing worker absenteeism.

But it isn’t a paperwork service, it is a third-party managed care company which promises its clients that it will manage, track and report the care, compliance and progress of each employee — all to contain costs and ensure shorter absences.

Reed Group’s services are medical care management (their’s not your doctor’s). Dr. Wes will love that!

It is mandatory managed care that people essentially must agree to (they call it "reverse triage" - you will get a call from one of their nurse managers), in order to take advantage of leave that is part of their employee/insurer benefits, much like the compulsory managed care (“medical home”) program being implemented for Medicaid recipients to receive public healthcare benefits. Mandated managed care is increasingly infiltrating itself into the ability to access any healthcare benefits that are being paid by someone else: namely governments, insurers or employer groups, who have worked behind the scenes for years to lay the groundwork. They have ways of making you do what they want.

Reed uses its own clinical guidelines to “improve absence management,” insure efficient care and reduce “unexplained variations in care.” The Reed Group’s The Medical Disability Advisor, Fifth Edition says it “provides benchmarks showing the expected period of absence based on condition and type of work,” while its Utilization Management Knowledgebase and Occupational Medicine Practice Guidelines “present expected courses of treatment.”

The benefits promised to employers are “cost containment with reduced short and long-term disability and workers’ compensation expenses,” tracking of costs and lost work time. Noncompliance with their managed care will no doubt ensure the quick end to benefits.

Being an outside contractor, Reed Group’s services are not bound by HIPAA privacy regulations and your entire health record can be used and shared any way the company chooses. Its website describing its services for employers clearly states that it will improve communication among employees, providers and administrators. [Note that their form even admits that information on HIV or AIDS infection, drug and alcohol abuse and psychiatric problems is among the information that can be shared, even if it doesn't relate to your primary diagnosis or reason for medical leave.] With full access to your records, they will ensure employers’ benefit administrators know anything that might impact costs for the employer.

As Dr. Wes said: “Welcome to the world of ‘Insurance Catch-22.’”