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Blue Cross asks doctors to rat on patients

Doctors balk at request for data

By Lisa Girion
Los Angeles Times
February 12, 2008

The state's largest for-profit health insurer is asking California physicians to look for conditions it can use to cancel their new patients' medical coverage.

Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," including "pre-existing pregnancies."

"Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately," the letters say. The Times obtained a copy of a letter that was aimed at physicians in large medical groups.

(WellPoint spokeswoman Shannon) Troughton said Blue Cross sent the letters to medical groups that operate, in effect, as health maintenance organizations. Blue Cross pays such groups a set amount per patient each month. With a few exceptions, the groups are then responsible for arranging and providing patients' medical care and take on a substantial piece of the risk.

Troughton said "in the past" physicians in such medical groups had requested information on patients' pre-existing medical conditions because anything that had not been disclosed could affect the medical group's finances.

It was important, Troughton added, "to note that participation in this outreach effort is voluntary on the part of the physicians."

"We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality," said Dr. Richard Frankenstein, president of the California Medical Assn.

Anthony Wright, executive director of HealthAccess California, a healthcare advocacy organization, said the letter had put physicians in the "disturbing" position of having to weigh their patients' interests against a directive from the company that, in many cases, pays most of their bills.

"They are playing a game of 'gotcha' where they are trying to use their doctors against their patients' health interests," Wright said. "That's about as ugly as it gets."

http://www.latimes.com/business/la-fi-bluecross12feb12,0,4319662.story

Comment:

By Don McCanne, MD

WellPoint's Blue Cross of California remains a leader in introducing innovations that reduce expenditures for health care. By limiting spending on health care they have been able to market their insurance products at highly competitive premiums, thereby reaping profits on this large, very healthy sector of our population.

As we have seen before, Blue Cross's very successful business model is often in conflict with the mission of physicians and other professionals to provide the health care that patients need. This letter to physicians has a particularly nefarious intent.

Since Blue Cross is paying these physicians a set amount per patient per month (capitation), the physicians themselves are providing an insurance function of assuming risk. Patients with greater health care needs result in a loss since the expenses required to care for them are greater, sometimes much greater, than the capitation payment made by Blue Cross.

So now we see why a physician might consider "ratting" on his or her own patient even though it would result in a rescission of the patient's insurance policy. Blue Cross does not have to put in print the very strong message of this letter, even though it will jump out between the lines.

"Doctor, your dishonest patient who lied on the insurance application will result in a financial loss for you, not to mention the need to provide additional professional services for which you will not be compensated. Fortunately, you can prevent this loss by notifying us of any medical condition that will allow us to rescind this unfair insurance contract."

To enhance profits, the private insurance industry is destroying the sacred relationship between the patient and his or her health care professional.

And the politicians are campaigning with the message that we can keep the private insurance we have. Who would want to?