What is a Health Abstractor and What Do They Want?

I just finished reading a good article by Dr. Dan Gold. This is my take on his article in the Great Falls Tribune. You can read his article in its entirety at the web site in the source section of this article. If you are getting unsolicited phone calls from your health insurance company, it could be from a hired health abstractor. With the new health care law hanging over every one's head, insurance companies might be taking it to another level.

What does an abstractor do?

A health abstractor calls you on the phone and tries to gather health information on you and those that they cover. They then relay this health data to your insurance company. I came across this job posting for a medical abstractor. It outlines their job description. The companies then determine what programs would benefit you and them in terms of health care management.

Health care information is privileged and private. You don't have to give out that information, unless it involves paying out claims.

Abstractors contact you, because your personal physician is not suppose to disclose any of your personal information.

Why are insurance companies doing this?

They want more control over your records, health care, claims and yes premiums. Physicians are constantly being badgered into purchasing new electronic medical records by the insurance companies and the government. They tell the physicians that this for meaningful use. One meaningful use would be, that if something happened to your physician, your new physician would have easy access to your medical history.

Abstractors can download records and see if physicians are using the proper techniques and medicines. This way they can grade out physicians. Doctors with low scores could face lower insurance reimbursements.

Extra costs? Someone has to pay for these abstractors. This could mean higher rates. I have no idea how many abstractor would be hired by the many health care insurance companies. However, it could be in the thousands.

My Take

I have always felt that my family doctor know more about me, than an insurance company. I always thought that my job was to pay premiums and my selected insurance company was to pay out claims. It seems like that is changing.

On the other hand, if you are looking for a job, there should be plenty of these openings in the weeks to come.

sources; Dr. Dan Gold; GreatFallsTribune.com