Health Insurer Pushes Itself Into Doctors’ Exam Rooms

We at the Alaska Personal Injury Group have seen it again and again with insurers, and have documented the practices in this blog: insurers mercilessly attempting to reduce costs by withholding policy benefits owed to policyholders, all the while justifying outlandish premium rate hikes by claiming that costs are too high. As insureds, we have almost become jaded to the extraordinary level of intrusion by insurers into our personal lives as they wage this campaign. For example, we think nothing of having to wrestle with an insurer who challenges our physician’s prescription for medication-the insurer intrudes into our relationships with our physicians as if it belongs in the room with us and our physician, challenging the physician’s choice of medication, the length of prescription, and even whether we should have the medication at all.

One of the most outrageous moves by health insurers yet is a letter Blue Cross of California recently sent to physicians asking them to “rat out” (my wording) their patients who might have preexisting medical conditions, which, of course, would then allow Blue Cross to cancel the patient’s coverage for the treatment sought from the physician. WellPoint, Inc., the Indianapolis-based company that owns Blue Cross of California justified the move because it was (and where have we heard this before?) trying to hold down costs. This is apparently a justification for intruding upon one of the most sacred of relationships, that of physician and patient.

Blue Cross is actually forwarding to the physician the patient’s insurance application (!) along with the letter instructing that:”Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately.” To its credit, the California Medical Association contacted California insurance regulators immediately, explaining that the maneuver by Blue Cross was “deeply disturbing, unlawful, and interferes with the physician-patient relationship.”

The move by Blue Cross was its answer to recent fines imposed on it because of a systematic pattern of terminating policies when claims were made-it would accept applications and premiums from policyholders, but later cancel the policy based on mistakes in the applications, minor inconsistencies, and a poor application form designed to create the supposed failure to disclose preexisting conditions. (In the industry, this word for terminating the coverage is “rescission,” which hardly serves to capture the malice inherent in this practice.) Once a policyholder was terminated, the insured would be unable to obtain a new policy for the current illness because any other insurer would see the problem as a preexisting condition and would refuse to insure. Thus, those with serious illnesses like cancer were unable to obtain treatment or they faced financial ruin trying to pay for the necessary care out of pocket.

Another way for Blue Cross to have handled the problem, of course, is to have examined the applicant’s medical history at the time of the application to determine whether to accept the applicant as an insured. This process of analyzing the risk is called “underwriting,” and it is the insurer’s job to do this at the time the policy is sold. What Blue Cross is doing here is trying to force physicians to do their underwriting job for them, and to look for ways to keep from paying the costs of medical care long after it has already agreed to underwrite the risk and has already been paid its premiums by the policyholder for that very risk.

And another way for Blue Cross to cut costs is perhaps to cut executive salaries. Its outgoing CEO received in 2005 salary and bonus of $5.2m and a restricted stock award of $3.1m. Upon retirement, he received a lump sum of $31m, which did not include $55m in unexercised stock options he also received.

The physician’s job is to care for the patient, often at a time when that person is at their most vulnerable. The physician must be free to inquire about all medical history that might be relevant to care, and the patient must be free to trust the physician with that information. To make the physician an agent of the insurer so the insurer can, yet again, maximize profits at the expense of the insured who has already paid for their policy, is to destroy the foundation of the physician-patient relationship and ultimately to prevent the insured from getting effective medical care. Essentially, the physicians are being shanghaied by Blue Cross to help it defraud its own insureds.

This maneuver by Blue Cross is unconscionable. An insurer does not belong in the exam room with the physician and the patient. That relationship is sacrosanct and must remain so. Any physician worth his salt will tell Blue Cross this. And the California Department of Managed Health Care should let them have it with both barrels.

Source: Los Angeles Times:<,1,7937098.story;
Blue Cross Letter:<;
WellPoint Salaries:

Source: Los Angeles Times:

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