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Rochester (N.Y.) Democrat and Chronicle: Health insurers should agree to a code of conduct
Health insurers should agree to a code of conduct
David Hannan
Guest essayist
Attorney General Andrew Cuomo's recent announcement of a settlement with Excellus BlueCross/BlueShield regarding out-of-network reimbursements has shined the spotlight on a secretive practice by the health insurance industry that has adversely affected patients and physicians for many years.
The business policies that led to this historic settlement once again highlight the need for comprehensive reform of the practices of the multibillion-dollar profit-generating health insurance industry.
Short-changing patients and physicians is only part of this bleak picture. In 2007, most of New York's health insurance industry reached an agreement with the attorney general that required the companies that establish "profiles" of their panel physicians must ensure the profiles are established in a way that does not penalize physicians for providing clinically appropriate care to patients, even if such care is expensive.
In 2008, Excellus BlueCross/BlueShield entered into an agreement with the attorney general to reduce the hassles that were being imposed on physicians who sought to ensure their patients could receive appropriate diagnostic imaging services.
These settlements highlight the extent to which some health insurance companies have implemented policies to control costs at the expense of their enrollees — our patients — who seek to avail themselves of the coverage for which they (or their employers) have paid. But the settlements have only begun to scratch the surface of problems endured by patients and their doctors in dealing with health insurance companies. Patients continue to experience problems in seeking to obtain medically necessary care and appropriate prescription medications. Physicians continue to experience systemic problems in obtaining timely and fair payment for the care they provide to patients.
Many believe that these problems can be addressed voluntarily by the health insurance industry on a national basis. It is for this reason that the Medical Society of the State of New York sponsored a resolution that was unanimously approved at a recent national meeting of the American Medical Association. The resolution calls for the AMA to develop a voluntary code of conduct for the health insurance industry.
The purpose of the code is to articulate a series of principles that a health plan would have to follow when it creates policies that attempt to constrict medically necessary care, create drug formularies and truncate agreed-upon payment for care.
A voluntary health plan code of conduct would be premised on four key principles: clinical autonomy, transparency, patient safety and corporate integrity.
A code would help restore a balance between cost containment efforts and preservation of the patient-physician relationship. It is anticipated a code will be developed this spring.
The adoption of a code of conduct by the health plans themselves could go a long way toward assuring that litigation will not be necessary in the future. Hopefully, Excellus will be among the first to sign on.
Hannan is president-elect of the Medical Society of the State of New York.
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All News Items
August 26, 2010 - The Lund Report: The Best Care Possible: You're Worth It
June 14, 2010 - American Medical News: 10 things health insurers must do to regain trust; The AMA, with endorsement from 68 state and medical specialty societies, outlines steps health plans must take to be credible in the eyes of physicians and patients.
February 27, 2010 - Providence Journal: The creepy third person in doctor’s exam room
November 28, 2009 - Newport News Daily Press: MDs under attack
November 04, 2009 - The Hill: A code of conduct for health insurers
October 27, 2009 - WCBU-FM 89.9 (Peoria, Ill.) radio news
October 26, 2009 - WEEK (NBC - Peoria, Ill.): Developing a doctor-patient relationship
October 12, 2009 - Las Vegas Business Press: Here's a prescription: A health insurers code of ethics
September 09, 2009 - Maryland State Medical Society Resolution 14-09
August 29, 2009 - The Island Packet: AMA code puts doctors, patients in charge of care
August 28, 2009 - Baltimore Times: Group calls on health insurers
August 27, 2009 - Baltimore Times: Nursing Maryland back to health
August 20, 2009 - Lincoln Journal-Star: Pharmacists forced to serve insurers rather than patients
August 19, 2009 - WSTM-NBC3: Prescription medication battle heats up in Central New York
August 17, 2009 - New York State Senator Jeffrey D. Klein blog: For Health or Profit? Klein Unveils Sickly Scorecard of Major HMOs
August 17, 2009 - New York Daily News: Prescription Prescription drug coverage marred by bureaucracy, survey says
August 13, 2009 - Leading African American Groups Call On Health Insurers to Dismiss Restrictive Practices
August 13, 2009 - San Diego Union-Tribune: Bureaucracy won't contain costs
August 01, 2009 - Huntington, W.V. Herald-Dispatch: Insurers put stress on the physician-patient relationship
July 21, 2009 - Chicago Tribune: They authorized back surgery but denied his $148,000 claim
July 17, 2009 - American Osteopathic Association calls for Development of Code of Conduct
July 12, 2009 - Houston Chronicle: Another kind of remedy for the sick; Code of conduct would protect patients
July 07, 2009 - Washington Post: Health Reform: Who Holds the Reins on Care?
July 06, 2009 - NATIONAL HEALTH INSURER CODE OF CONDUCT HITS 1000 SIGNATURES OF SUPPORT
June 30, 2009 - Atlanta Journal-Constitution: Code of conduct needed for health insurers, too
June 24, 2009 - Penn. Pharmacists Association: “A Patient Walks Up to the Counter …”
June 24, 2009 - Pittsburgh Post-Gazette: Broken bonds; The physician-patient relationship is being destroyed by the cost-driven decisions of health insurers
June 09, 2009 - Bellingham (Wash.) Herald: Time for a health insurance code of conduct
June 08, 2009 - Mississippi Business Journal: Transparency is the best medicine; Health Insurer Code of Conduct may improve the quality of care
June 03, 2009 - Frederick (Md.) News Post Op-Ed: Pharmacists pawns in health care's game of chess
June 01, 2009 - KUSI-TV interview with Dr. Jack Schim
May 25, 2009 - San Francisco Chronicle: Doctor pushes back against insurer scrutiny
May 08, 2009 - Fox News Health Blog: Bad Medicine: Is Your Insurance Company Hazardous to Your Health?
April 27, 2009 - Petition for Health Insurer Code of Conduct Garners Widespread National Support
April 20, 2009 - On-line petition launched in support of a national health insurer code of conduct
April 13, 2009 - Petition launched in support of a national health insurer code of conduct
April 09, 2009 - Westchester (N.Y.) Herald letters: Access to Quality Healthcare
April 01, 2009 - Los Angeles Society of Allergy, Asthma & Clinical Immunology Applauds the AMA for Developing Health Insurer Code of Conduct
March 24, 2009 - Arizona Republic: Patient care, not financial gain, must take priority
March 22, 2009 - Rochester (N.Y.) Democrat and Chronicle: Health insurers should agree to a code of conduct
March 20, 2009 - Buffalo News: Code of conduct would protect patients from insurers
March 10, 2009 - AfPA Launches Petition in Support of a National Health Insurer Code of Conduct
March 09, 2009 - Texas Medical Society: Health Insurance Code of Conduct Act of 2009; The Time Has Come
March 09, 2009 - American Medical News: MSSNY president: Insurer settlements highlight need for code of conduct
February 01, 2009 - Colorado Medicine: Health Insurer Code of Conduct?
January 24, 2009 - Fresno Bee: Doctors push code of conduct for insurers
December 10, 2008 - Lupus Agencies of New York State Applaud AMA's Resolution to Develop a "Code of Conduct" for Health Insurers
December 09, 2008 - New York State Rheumatology Society Position Paper: AMA Resolution 823
November 20, 2008 - National Minority Quality Forum Applauds AMA's Health Insurer Code of Conduct
November 14, 2008 - Alliance for Patient Access Applauds AMA's Health Insurer Code of Conduct
November 13, 2008 - Alliance for Better Medicine Calls on California Health Insurers to Adopt a "Code of Conduct"
November 13, 2008 - Los Angeles County Medical Association Reinforces AMA's Call for a Health Insurer Code of Conduct
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