Wednesday, February 13, 2008

Wellpoint Halts Attempts to Have Doctors "Rat Out Patients"

We just discussed the sorry state of Merck Inc, whose founder once said, "Medicine is for people, not for profits," but now seems to be run by people who think otherwise, to the detriment not only of patients, but of the company and most of its employees.

Here is another example of a company that seems to put short-term financial gain ahead of its stated commitment to "improving ... lives."

Lisa Girion, writing in the Los Angeles Times, reported yesterday that Blue Cross of California, a subsidiary of for-profit Wellpoint Inc, has been "asking California physicians to look for conditions it can use to cancel their new patients' medical coverage." In particular,

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.

Please keep in mind that insurance companies usually request copies of medical records of people who apply for individual health insurance. However, Blue Cross of California was not simply requesting copies of records. It was asking the physicians to actively look through patients' records for information that could be used to cancel the patients' insurance. It was no wonder that physicians were
'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.

Patients 'will stop telling their doctors anything they think might be a problem for their insurance and they don't think matters for their current health situation,' he said.

The California Medical Assn. sent a letter to state regulators Friday urging them to order Blue Cross to stop asking doctors for the patient information, saying it was 'deeply disturbing, unlawful, and interferes with the physician-patient relationship.'

Blue Cross' explanation frankly made no sense: "Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members,"

Today, Ms Girion reported even more outrage, starting with physicians:

Robert Margolis, a physician and the chief executive of one of the state's largest medical groups, described the letters as "an obnoxious intrusion" on the relationship between physicians and patients.

"Asking us to be the application police is inappropriate," said Margolis, who heads HealthCare Partners Medical Group in Los Angeles.

Some famous politicians got into the act.

[California Governor Arnold] Schwarzenegger sharply criticized the practice, which he described as akin to telling physicians to "rat out the patients and to give the patients' medical history to the insurance company so they have a reason to cancel the policy."

The governor said the practice should be banned.

"That is outrageous," he said, and "one more reason why it is so important to have comprehensive healthcare reform."

Democratic presidential contender [NY Senator Hillary] Clinton said the Blue Cross effort was another "example of how insurance companies spend tens of billions of dollars a year figuring out how to avoid covering people with health insurance."

Somehow, one day after it was revealed that Blue Cross was sending the letters, the company decided to stop, with this burst of business-speak [highlighted in red],

Today we reached out to our provider partners and California regulators and determined this letter is no longer necessary and, in fact, was creating a misimpression and causing some members and providers undue concern.

As a result, we are discontinuing the dissemination of this letter going forward

You just can't make this stuff up. On one hand, underlying the sending of these letters is the irrational system the US has for providing health insurance based on employment status.

On the other hand, Blue Cross' aggressive attempts to cancel peoples' policies contradicts Wellpoint's pledged "commitments."

At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. From the boardroom to the mailroom, every associate is expected to honor the company's commitments to our diverse customers, fellow associates, shareholders and the communities we serve - helping us become the most trusted choice among consumers.

Our business strategies mirror our commitment to providing affordable quality care to our members and the public.

Wellpoint is becoming an amazing example of a health care company whose management seems completely hostile to its stated warm and fuzzy mission of "improving the lives of the people we serve." In the past, we have discussed how Wellpoint (and/or its units)
  • misplaced a computer disc containing confidential information on 75,000 policy-holders (see post here)
  • settled a RICO (racketeer influenced corrupt organization) law-suit in California over its alleged systematic attempts to withhold payments from physicians (see post here).
  • was fined for cancelling individual insurance policies (again in California) after their holders filed claims (see post here)
  • was found to have mis-handled at least half of its revocations of individual policies (see post here)

This sort of corporate culture and corporate leadership within health care has to be responsible for a good measure of the rising costs, poor access, and stagnant quality that are repeatedly lamented, yet seem resistant to conventional policy solutions.

Fixing this problem will require changes in the education of health care leaders, the culture of health care organizations (starting with public and enforceable commitments to ethical leadership), and unavoidably some imposition of the heavy hand of government regulation.

Such changes will provoke considerable opposition from those in the power elite of health care who have become rich and powerful under the current system. This opposition will doubtless be noisy and intimidating, given that health care's power elite has plenty of money to finance it. (Perhaps to overcome it, Governor Schwartznegger would be willing to put on his "Terminator" costume and visit a few health care CEOs to persuade them not to seek the "ratting out" of more patients.)

But as long as health care organizations' leaders are more interested in acquiring power and money than in serving patients, patients will remain at the bottom of the heap.

ADDENDUM (15 February, 2008) - On the Covert Rationing blog, DrRich noted that the first LA Times story (see above) included an assertion by Blue Cross that for a long time it had been sending many letters to doctors asking them to help the company find patients who had medical conditions not revealed on their applications for individual policies. DrRich thought that these letters had gone to physicians who were paid by capitation, and that therefore might have been motivated to have sicker patients leave their practice. If that was the case, this would suggest how perverse incentives could influence physicians to betray their core values, including making care of their individual patients their first priority, and protecting the confidentiality of patients and their medical records. However, the article noted that many physicians said they had never seen such letters before. Perhaps Blue Cross enlarged the population of physicians receiving letters. Perhaps who really got what letters when is not yet clear. In any case, it appeared that the letters asked, if not demanded physicians betray their core values. I can only hope that not too many physicians let the letters influence them to do so.


Anonymous said...

Could you comment on insurance companies' (in general not just BCC) right to use exhaustive means at their disposal to prevent fraud & abuse by enforcing the required honest & full disclosure of an applicant's pre-existing medical conditions?

InformaticsMD said...

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,'

What jackasses and morons - I'm sorry for the frank language - came up with this notification of doctors?

You have to be at least a jackass and/or a moron not to realize this would REALLY upset doctors.

Anonymous said...

MedInformaticsMD pretty much covers it. What is also troubling is the weak use of biz speak as an attempt to cover up the situation. You would think someone could come up with something less contrived.

Steve Lucas

InformaticsMD said...

Jane said:

Could you comment on insurance companies' (in general not just BCC) right to use exhaustive means at their disposal to prevent fraud & abuse by enforcing the required honest & full disclosure of an applicant's pre-existing medical conditions?

Yes, they can use "exhaustive" means, just not means that interfere with the doctor-patient relationship or would put, say, pregnant women out on the street, see my followup post "Blue Cross of California - Wellpoint to Use EMR's to Deny Women Prenatal Care and Encourage Abortions, it follows...".

That dr-pt relationship exists, as it has existed since the timeo f Hippocrates, to serve the patient, not the payer or other third party.

Jane, I hope your physician has your best interests at heart.

A rhetorical question: don't you also wish for that, or would you rather your doctor, or that of your children, or parents, or grandparents, thinks of the payer first, then the patient second?

Anonymous said...

It is almost amusing to me that people are so outraged over this. Get a Life! Doesn't the health care companies require the applicant to state thier medical history when applying? So where is the privacy issue. The doctors were only asked to verify. Would it be better if health insurance companies required a physical "before" giving insurance? What that make it better or do you have a problem with that too? Auto insurance companies give insurance based on your driving history and risk. there is not one flat fee for everyone. Why is the health care companies blamed for the cost of health care? Maybe health care would not cost so much if the doctors and hospitals did not change so much? Who is suppose to pay for health care? This is not a charity. A company should be able to make a profit like any other business as long as it is not gross profit.

Health care reform? You really want health care to be run by the government? How do you like the service you get at the DMV? Social Secuiry office or any other government run agentcy?

The fact that there are health care companies out there gives you a better chance of getting good health care coverage because there is competition.

The only people that complain about health care cost is those who cannot afford it. Thise who cannot afford it must not have a decent job.

Get a life, get a job!


Roy M. Poses MD said...

Re "John's" comment -

The letters appeared to ask doctors to actively seek out patients' medical problems that were not listed on the insurance application form. They thus appeared to ask the physicians to put the insurance company's financial interests (to avoid patients likely to make more claims) ahead of the confidentiality of the patient's medical record, and to violate the first commandment of medical ethics, to put the care of the individual patient ahead of all other considerations.

What is particularly unfair about the US health care system is that these sort of abuses only affect people who buy individual health insurance policies, that is, those employed by small businesses or self-employed. Employees of big businesses are accepted by insurers as a group, are not individually subject to medical underwriting, and are not individually excluded from coverage for pre-existing conditions. What is fair about treating employees of large corporations better than everyone else?

Most of the rest of this comment was irrelevant to my post, and to Health Care Renewal (which surely has plenty of posts criticized the government, CMS, Medicare, and does not advocate for health care "run by government.")

Anonymous said...

Thanks for keeping a seemling cool head after my rant. I just think that people need to stop putting all the burden on health insurance companies to solve the health care issues. Obviously if a seemingly healthy patient get coverage when they really have cancer or other condition, the health insurance company would lose money in that case and many of those would put the company out of business and then there would be no health insurance.

A person should have the right to get coverage and pay accordingly to thier condition. If they cannot afford it, then maybe thier could be some other subsidies.

In an ideal world, people woudl eat right and get regular check ups and then maybe they would be less likely to put themselves in an situation where they cannot afford health care. The problem is some poeple do not get health care until they need it, then they cannot get it. If they would just get it when they are healthly, they would never be canceled or denied.

One thing health insurance companies are doing that I think is genious is - being proactive with the insured and giving them incentives for having regular checkups etc. Then, the patient is health and the insurance company will keep collecting premiums with fewer claims. thus more profit. I see nothing worng with that, it is a win win. People will still keep their insurance.

Just my opinion..

Anonymous said...


You may want to review the Feb. 5th AP story regarding lifetime health cost and the obese, smokers and the healthy. It seems it cost more to cover the healthy due to their long life than the other groups, which tend to die younger, and thus incur lower cost.

Healthy $417,000, obese $371,000 and smokers $326,000. The insurance companies desire may be to shift those cost to the government as most people are required to go on Medicare when able by their existing insurance company and employer.

Steve Lucas

InformaticsMD said...

I note that "John" failed to critique my comments and my followup post on this issue ("Blue Cross of California - Wellpoint to Use EMR's to Deny Women Prenatal Care and Encourage Abortions, it follows...").

What "John" cannot spin away is the breathtaking idiocy of the Blue Cross employees and leadership in coming up with such an ill-conceived, predictably embarrassing message and plan.

They most certainly embarrassed the company, spectaculary so, and on a nationwide basis per a google news search.

Generally when people do this, they get fired.

Also, to those influential people who read HCRENEWAL, make note: insurance co. employees so dim-witted to have come up with this hairbrained scheme, a scheme that shows no understanding of and/or contempt for medical culture and ethos - may very likely have done other equally stupid things.

A red flag, as it were.

I believe an audit of company-related activities related to the people who architected this fiasco is not unreasonable, to ensure the integrity of the company's other programs and actions.