Blue Cross Plans Develop Guidelines for Treatment Discussions
Under new guidelines developed with the American Medical Association, the Blue Cross and Blue Shield Association will encourage doctors to discuss all treatment options with patients, "criticizing" the "gag rules" some health plans place on physicians, the AP/Akron Beacon Journal reports. The AMA has been a "leading critic" of such gag rules, which prevent doctors from discussing all available treatments and tests with patients, the AP/Beacon Journal reports. Scott Serota, president and CEO of the Blue Cross association, said that mandating gag rules "is not the way we operate," adding that the guidelines represent an attempt "to stop the fingerpointing" and "build collaboration with doctors." Under the guidelines, health plans will still make coverage decisions, but Blue Cross and Blue Shield plans will "actively solicit and promote physician involvement" in decisions affecting patient care. Patients also should have access "to a timely, expeditious internal appeals process" if a health plan denies coverage, the guidelines say. Dr. Donald Palmisano, a AMA board of trustees member, said that although the guidelines "don't solve all conflicts with the insurance industry," the represent "a step in the right direction." He added, "[N]ow we'll have to see how [they're] implemented" (Tanner, AP/Akron Beacon Journal , 5/16). The guidelines are available at http://www.bluecares.com/newsmedia/Guid_PDF.pdf. Note: You will need Adobe Acrobat Reader to view the file.