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Atlanta Journal-Constitution: Code of conduct needed for health insurers, too
Guest column
By Christina Mayville
The American Medical Association (AMA) is considering a national health insurer code of conduct, calling on the U.S. health insurance industry to adopt consistent practices regarding costs, business transparency and the physician-patient relationship.
While health care providers — physicians, nurses, hospitals — adhere to strict professional and medical codes, no similar protocols exist for insurers. And although regulated to some extent like many industries, health insurers have had no meaningful self-regulation — an important business practice and one that a code of conduct ensures.
This is important because health insurers are the primary bridge between physicians and their patients, between hospitals and physicians, and between patients and hospitals. Health insurers should provide easy access to necessary health care. But they often are an obstacle.
In my neurology practice, I often encounter situations that demonstrate the need for such a code of conduct. Recently, a patient whom I’d seen regularly presented with a new neurological problem that did not seem related to the chronic condition for which he is routinely followed. I requested a new diagnostic test and went through the usual procedure for a “precertification” for the test, required by the insurance carrier. The carrier denied it.
The patient then developed problems and went to the emergency room. After the patient was transferred to another facility, the neurological test I’d originally asked for was conducted and confirmed a brain tumor. What’s worse, the patient initially was given a different test in the ER that erroneously suggested the possibility of a stroke.
If the recommended test had been approved to begin with, the subsequent emergency room visit, transfer via ambulance and additional, more costly testing would have been avoided. The patient would have been admitted to the hospital and had a routine, rather than emergency, consultation and operation.
This may sound like an extreme example of a system not working, but this is not an uncommon scenario.
The AMA’s proposed code of conduct will lay out clear principles to be followed by health insurers, addressing medical and payment issues, monitoring and compliance frameworks, and restrictive practices that damage the physician-patient relationship.
It seeks to shine a light on any third party who influences the health care of a patient, ensuring that the physician provides that care — not a managed care company — and that no unauthorized changes are made without the knowledge of the physician and patient.
Health care reform has stepped onto the stage in Washington. Much debate will take place about what needs to be added and what needs to be fixed. Holding the health insurance industry accountable — to itself — is a strong starting point.
Dr. Christina Mayville is a neurologist in Macon.
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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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