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The Hill: A code of conduct for health insurers
By David Charles, M.D.
While the debate over healthcare reform continues in Washington, America’s doctors have been quietly moving ahead with plans for a first-ever code of conduct for the nation’s health insurance industry.
Such a code is a badly needed reform that must not be pushed aside, no matter what kind of healthcare legislation is eventually passed and signed by the president.
The American Medical Association is developing the draft for a Health Insurer Code of Conduct. Why is the medical profession proposing this code instead of the insurance industry? It’s because physicians too often find themselves trying to help patients cope with insurance companies that deny or delay the care they need.
While the healthcare reform debate initially focused on the 47 million Americans without health insurance, it soon expanded to include the chronic frustrations of many Americans who do have health insurance. At public hearings and in news interviews Americans have poured out their frustrations over insurance companies that denied them coverage for diagnostic procedures, hospitalization, treatments, or drug therapies prescribed by their doctors.
Regardless of opinions on how health insurance should be reformed, most Americans cherish their doctor-patient relationship. The darkest fear most of us have about a government-run healthcare plan is that government bureaucrats would be overturning the recommendations of our doctors.
Yet this kind of trespassing on the doctor-patient relationship already happens daily in American healthcare. It happens every time a patient has to apply for pre-certification from an insurance carrier in order to have surgery or other treatments recommended by their physician. And it happens when insurance plans substitute a prescribed drug with another, cheaper brand.
Millions of Americans are arbitrarily denied coverage for a specific treatment or, less frequently, summarily dropped from coverage altogether after they become ill. The challenge of contesting these decisions is complicated by each insurance carrier having its own combination of hard-and-fast rules and by arbitrary decisions that ill patients too often don’t have the stamina or resources to battle.
It shouldn’t take the patience of a saint and the threats of a trial lawyer for an insured person to get the treatment his or her doctors prescribe.
Work on the AMA draft for a Health Insurers Code of Conduct is in its early stages; a first draft will be presented to the AMA House of Delegates in November. The fundamental message of such a code for insurers, however, is already clear: Put patients first. Unfortunately, in some insurance plans the patient’s best interest is too often subjugated to the profit margin of the company.
Insurance companies have a financial incentive to deny as many pre-certification requests and claims as possible. This might make a short-term profit, but this resistance to legitimate patient needs is adding to America’s overall healthcare costs.
New research shows that medical practices across the country report spending $31 billion a year on the administrative costs of dealing with health insurance plans. Physicians in one survey reported spending the equivalent of three weeks a year dealing with insurance-related matters. I can confirm from personal experience that much of that time and money is spent helping patients over the bureaucratic hurdles of the insurance appeals process.
A health insurer code of conduct truly focused on patient welfare could minimize these problems and increase Americans’ satisfaction with whatever form of health insurance they choose. Hopefully the AMA can draft a plan that insurers would see the value of adopting voluntarily. If not, Congress might have to translate some version of the code into law.
Either way, a code of conduct is essential because we will never achieve meaningful healthcare reform in America without meaningful reform in the way health insurers respond to patient needs.
The author is chairman of the Alliance for Patient Access, a doctors group not affiliated with the AMA. He is vice chairman of neurology at Vanderbilt University.
READ THE ORIGINAL ARTICLE
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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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