Outrage over claims about Blue Cross

February 12, 2008 12:00:00 AM PST
Documents that suggest Blue Cross is encouraging doctors to reveal information about their patients is outraging many people. They say Blue Cross is doing this in order to cancel their coverage. It's a harsh dose of the business of medicine that's not going down very well.

California's medical community is appalled over letters Blue Cross has sent out to doctors, asking them for health histories of new customers that might enable them to cancel insurance coverage. The state's largest for-profit health insurer requested that "any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately."

"If my patient thinks something they might say to me is going to cause them to lose their health insurance, I'm afraid they won't give me all the information I need to get them the best healthcare they can have," says Richard Frankenstein, M.D.,President, CA Medical Association.

The letters made it all the way to the Governor. He's been working for more than a year to fix the healthcare system and today vented his frustration with healthcare leaders over what he calls the "ratting out of patients."

"People that are uninsured have to live in fear. People who are insured have to live in fear. This is outrageous, and we have to go after those people and straighten it out," says Gov. Arnold Schwarzenegger, R-California.

Blue Cross says it is within its right to cancel policy holders who were not truthful in their application for medical coverage. In a statement today, Nick Garcia said:

"The notification process has been in place for several years and to date, we have not received any calls or letters of concern ... It is important to note that of the approximately 300,000 new individual Blue Cross members each year, this letter pertains to less than 1000 HMO members per month."

Consumer groups are warning this practice can't go on. It's not fair to either the doctor, or the patient and it protects the insurance company's profits.

"The doctor is in a very difficult position because after all, he gets paid by the insurance, but his first duty is to the patient. So this is an outrageous situation," says Beth Capell, HealthAccess California.

State regulators will be looking at how much responsibility doctors have in the underwriting process. Before that investigation is over, a proposal will be presented to take doctors completely out of the underwriting picture.


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