Thursday, February 14, 2008

Blue Cross of California - Wellpoint to Use EMR's to Deny Women Prenatal Care and Encourage Abortions, it follows...

I commented on the "irrational exuberance" over healthcare IT here. Health IT is a double-edged sword. It can be used, and it can be misused. In the hands of the wrong people, it will "revolutionize healthcare" all right ... but not in the direction health informaticists and clinicians would desire.

The title of this post seems the logical outcome based on the self-initiated debacle of Blue Cross of California, as posted at Wellpoint Halts Attempts to Have Doctors "Rat Out Patients":

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 full extent of the "medical derangement syndrome" represented by this incident calls for elucidation that seems absent in the main stream media.

First, a plan seeking to deny coverage that specifically singles out a "condition" of "pre-existing pregnancy" is heartless beyond hope:

  • Is pregnancy now considered by Wellpoint to be merely a "pre-existing condition?"
  • What about women who might not have known they were pregnant at the time of application? With the history of Wellpoint's cancellation of policies, how would such situations be adjudicated, and how rapidly considering the clinical time windows involved?
  • Why would such patients be subject to cancellation instead of rate adjustments? Who was to make that determination? What was it to be based on?
It seems to me that the intent was to deny coverage to pregnant women who did not for whatever reason disclose their pregnancy, thus pushing them towards inadequate prenatal care and/or abortions.

I would like to know the answers to the following:

  • Who conceived this policy and the announcement? What committee and executives approved it?
  • Did they have any idea of the all too predictable physician reaction? If yes, did they care?
  • If they knew the likely reaction and did not care, why are these people in a position of authority in healthcare?
  • If they did not know the predictable reaction, what are people so utterly divorced from medical culture and ethics doing in a position of authority in healthcare?
  • Who hired these people?

Finally, being denied access to physicians "ratting out" their patients, it's likely Blue Cross of California will resort to using Health Information Technology and Electronic Medical Records data from physicians to provide the same information.

In effect, it seems Blue Cross of California - Wellpoint will use EMR's and other healthcare IT to deny people coverage, including denying women prenatal care and probably pushing them to have abortions.

Is this the "revolution" health informaticists had in mind when we began advancing the field of computing in medicine?

With regard to their statement "As a result, we are discontinuing the dissemination of this letter going forward", the business-speak spin term "going forward" is best translated as:

We got caught doing some seriously bad sh*t, but let's just sanitize it and brush it under the carpet.

Finally, I find it pathetically ironic that this organization expects potentially hostile-to-self-interest honesty out of its subscribers about their medical histories, when as Roy Poses pointed out, their own corporate history includes:

  • Settling a RICO (racketeer influenced corrupt organization) law-suit in California over its alleged systematic attempts to withhold payments from physicians (see post here).
  • Being fined for cancelling individual insurance policies (again in California) after their holders filed claims (see post here)
  • Being found to have mis-handled at least half of its revocations of individual policies (see post here)
Perhaps honesty best begins at home.

-- SS

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