Each one of these CPT codes has a price associated, a physician effort number, a non-physician effort number, and usually includes in the cost all the specific supplies that might be needed for each one. This tells your Insurer what your Dermatology "Provider" did, and what they expect for reimbursement.
Then they look at the complaint that made you call the doctor which is the "L25.5" (Contact Dermatitis caused by contact with plants) and the "L82.1" tells your insurance company or Medicare that the doctor thought you may have after he examined you, which might be "Seborrheic Keratoses".
This is a lot of information, stored in a database. All that personal and individually defining information, as well as the detailed information about what you went to the doctor for and what was found.
You have an account with YouTube (Google). And it may only have your name, date of birth (for age verification to watch videos) and email address.
But don't you think, if YouTube (Google) had access to some database which might have your name, date of birth, and email address in it, couldn't there be pretty accurate match up?
At some point, if YouTube (Google) has access to a database with that information, is it far-fetched to envision Google running some process that takes username Doe, John (Not_who_u_think) DOB, and email and compares it to a medical billing database or transaction, finding a match, and feeding that user videos or other information.
How would YouTube (Google) get access to a database? I don't know. It might be illegal, for all I know. Someone in CMS (Center for Medicare Services) might give them access.
Or, it could be all legal and above the board. How many people carefully read the Consent Form for treatment at a medical facility? And how many people perfuse the YouTube (Google) agreement when they create their account?
Fewer than one would think. It is possible there could be wholly legal gobbledygook in there that baldly states YouTube (Google) can legally mine systems for your data?
And isn't Google dabbling in the Healthcare space? LINK: What is Google Health?
You get the idea.
There may even be a provision in the so-called "Affordable Care Act" that not only allows and encourages it, but even PAYS for it.
That sounds crazy, but when you realize that By the count of an organization called "The Regulatory Review", the final version of the ACA amounted to 961 pages, or about 475,000 words, which so far have triggered 265 unique rulemaking activities. These regulations translated to almost 9,000 pages, or more than 9,000,000 words, that were finalized by the end of 2019.
There could be anything in that bureaucratic snake pit called the ACA that would allow payors to share information with entities who have signed on to improve care.
“I am spitballing here, so take it for what it is worth. We want to examine how YouTube might know how to present you with content automatically that you might act on? Content like videos on “Seborrheic Keratoses” that may have been made by Pfizer with information about the condition, and also makes prominent mention of treatment using that drug? Right? I assume that is what has your head spinning.
How could we draw a line from someone in your Dermatologist’s office putting it on a bill for submission, to a website like YouTube (Google) that knows your identity when you login and feeds you information tailored to you?
Again, I have no idea, this is just conjecture. Here is a primer that describes the medical performance and payment process, and this long segment is to show how your information gets into a computer system. And there is a lot of it.
When you see your provider (your Dermatologist) and he sees you and then finishes the report on your visit, his office billing system system creates a bill for submission to your insurance company for payment, and that bill has a multitude of informational items on it that gets sent electronically to your insurer. Name. Address. Email. Cell phone. Date of Birth. Social Security Number. And a huge tranche of other items.
Plus, in addition to all that, you have...the ICD-10 code your Dermatologist applied to your condition of “L82.1” floating in that rich soup of very personal information. THAT piece of information, “L82.1” tells your insurance company or Medicare that the doctor thought you may have after he examined you, which might be “Seborrheic Keratoses”. (They may also include an ICD-10 code for what you came in for, which might be an L25.5 (Contact Dermatitis caused by contact with plants which is what you told the person on the phone when you noticed it and thought you might have gotten it from clearing heavy brush on your property)
Also, they have to tell your payor (Insurer) what services they are billing for. For this, they might use what is called a CPT code. It is a special medical code that describes a plethora of medical activities or procedures. In this case let’s say you called up, got a fifteen minute appointment with the Dermatologist to take a look, and during the examination, he takes two scrapings of affected areas on your body. Perhaps one scraping from the neck, and one from the scalp. (again, I don’t know know anything about Seborrheic Keratoses, but lets say it is a bumpy rash-like thing that might be on a few areas of your body, and they have to get scrapings to send off to Pathology for analysis.
Your Dermatologist says something like this to you: “Hmm. Hm. Okay. This looks like skin condition called “Seborrheic Keratoses”. It isn’t painful or especially dangerous, but it may be visible to others, and people often have them removed if they are on their face or hands. A very small number of them may become skin cancer. And you will probably get more of them as you get older. Why don’t I take a biopsy of them by gently scraping a few, one on your neck and one on the top of your head, and have them analyzed to be sure?”
Then he puts on some gloves, scrapes the areas with some implement and puts the tissue scrapings into some container, writes you a prescription for some cream to rub on it three times a day, and says he will contact you when he gets the results back.
He writes up the notes for the visit, and submits them to a secretary or medical assistant who gets them into a system, and they “close” the case to say they are done treating you for that visit on that day. That night, some background process runs on the computer systems, and all those “closed visits” for the day are collected by the software, and sent to a queue where someone with special skills may analyze the bill further and buff it up for submission, making sure there are no contradictions or inappropriate billing items. Or, they may add additional billing items that didn’t get automatically put on the bill.
(NOTE: I am only guessing what CPT codes might be applied, and I just looked these up on some random web page I looked up on Google) you probably had something like these things billed for:
CPT Code: 99213 (Office or other outpatient visit for evaluation and management of an established patient for 15 minutes.)
CPT Code: 11102 (Tangential biopsy of skin; single lesion.) (the scraping or biopsy of your neck)
CPT Code-11103 (Tangential biopsy of skin; each separate or additional lesion.) (the scraping or biopsy of your scalp)
CPT Code-T84431 (AI assisted analysis of dermatologic lesions) (NOTE: I just made this up. But something like this might well be employed.)
Each one of these CPT codes has a price associated, a physician effort number, a non-physician effort number, and usually includes in the cost all the specific supplies that might be needed for each one. This tells your Insurer what your Dermatology “Provider” did, and what they expect for reimbursement.
Then they look at the complaint that made you call the doctor which is the “L25.5” (Contact Dermatitis caused by contact with plants) and the “L82.1” tells your insurance company or Medicare that the doctor thought you may have after he examined you, which might be “Seborrheic Keratoses”.
This is a lot of information, stored in a database. All that personal and individually defining information, as well as the detailed information about what you went to the doctor for and what was found.
You have an account with YouTube (Google). And it may only have your name, date of birth (for age verification to watch videos) and email address.
But don’t you think, if YouTube (Google) had access to some database which might have your name, date of birth, and email address in it, couldn’t there be pretty accurate match up?
At some point, if YouTube (Google) has access to a database with that information, is it far-fetched to envision Google running some process that takes username Doe, John (Not_who_u_think) DOB, and email and compares it to a medical billing database or transaction, finding a match, and feeding that user videos or other information.
How would YouTube (Google) get access to a database? I don’t know. It might be illegal, for all I know. Someone in CMS (Center for Medicare Services) might give them access.
Or, it could be all legal and above the board. How many people carefully read the Consent Form for treatment at a medical facility? And how many people perfuse the YouTube (Google) agreement when they create their account?
Fewer than one would think. It is possible there could be wholly legal gobbledygook in there that baldly states YouTube (Google) can legally mine systems for your data?
And isn’t Google dabbling in the Healthcare space? LINK: What is Google Health?
You get the idea...”
Thank you for your thoughtful reply, and I believe you’re on target.
I know a little about ICD-10, and yes, matching up a name or
email, or just a good guess might single me out. And of course, my insurance company knows everything.
As a postscript, after that one video suggestion, there have been no others about the condition or even the topic in general — even though I watched it, which usually triggers several other videos on the same topic.
Weird. I’m not ready to believe my phone is spying on me, but I can see this chain of events leading to the result.