how does that not violate HIPAA ? I see it talking about "you can proactively opt out with hipaa" but everything I've ever seen about HIPAA is that all "opting in" needs to be explicitly granted by the patient.
https://www.rxhistories.com/irix/medical-data/
>How It Works
>1 Applicants sign a HIPAA-compliant authorization, enabling insurers to retrieve their medical information
>2 Insurers electronically query Milliman IntelliScript in real-time
>3 Milliman instantly gathers information from multiple data sources
>4 Irix interprets the data and generates automated decisions based on the insurer's guidelines
From "Pharmacy privacy Requirements here [1], I don't think "business associate agreement [with] some vaguely care-adjacent purpose" meets the standards for information-sharing. Rather the information must be being shared as part of specific treatment for a patient (discussing actual care) or payment.
[1] https://www.uspharmacist.com/article/hipaa-privacy-security-...
HIPAA is a fig leaf. Cardboard covers on clipboards to inconvenience the nurses and receptionists, but a unencumbered infobahn for anyone who touches the money to drive straight through.
For decades, every visit, test, procedure, and medication you've ever had paid for by a health insurer in the US got dumped straight into MIB, where any insurer could look at it. HIPAA functionally changed this not a whit.
I think this is what the GP was referring to. It's not just for care but for payment and operations too. A few operational examples, in the case of pharmacies, they must make sure that a patient doesn't fill the same prescription twice. Health insurance companies receive clinical data from health care providers for the purposes of HEDIS reporting.
Don't forget, the second P in HIPPA is portability.