Insurer asks docs to report on new patients with pre-existing conditions
Blue Cross of California recently asked doctors to look for pre-existing conditions that could be used to justify the cancellation of insurance policies held by new patients, according to the Los Angeles Times.
"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,'" the newspaper reports.
Dr. Richard Frankenstein, head of the state medical association, says his group is "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."
Thanks to the Internet, you can read the letter Blue Cross sent to doctors at large medical groups that operate like HMOs. Here's an excerpt:
Health history discrepancies are commonly identified using the following sources:
1) Health history questionnaire...
2) Pre-existing pregnancies. Identified when the last menstrual period date is prior to the agreement's original effective date.
3) Elective and emergency surgeries performed within the first year of the original agreement effective date.
4) Member requests for specialty referrals outside the medical group to providers who previously provided care.
5) Member requests for specialty referrals within the medical group for chronic conditions.
6) Claims from outside providers requesting payment.
7) First year hospitalizations.
A spokeswoman for WellPoint, the company that runs Blue Cross of California, tells the Times that the letter was designed to hold down costs by identifying policyholders who weren't upfront about their medical history when they applied for coverage.
But Byron Tucker, a spokesman for the Insurance Department, tells the Times that this letter is "extremely troubling on several fronts. It really obliterates the line between underwriting and medical care. It is the insurer's job to underwrite their policies, not the doctors'. Doctors deliver medical care. Their job is not to underwrite policies for insurers."
http:/www.usatoday.com/
