California Doctors Fight Blue Cross on Application Reviews
On Friday, the California Medical Association urged state regulators to order Blue Cross of California to stop asking doctors to report pre-existing medical conditions that could be used to rescind patients' health care coverage, the Los Angeles Times reports.
The insurer is sending physicians copies of new patients' health insurance applications along with a letter advising them to immediately report any "condition not listed on the application that is discovered to be pre-existing."
In the letter, Blue Cross also maintains the right to rescind members' coverage if they fail to fully disclose their medical history, including "pre-existing pregnancies."
CMA told state regulators that asking doctors to share patient information with insurers is "deeply disturbing, unlawful and interferes with the physician-patient relationship."
CMA president Richard Frankenstein said the policy could prompt patients to "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."
Doctors groups that received the letter from Blue Cross said the request was the first of its kind that they have received, the Times reports.
Shannon Troughton â€"- a spokesperson for WellPoint, Blue Cross's parent company -- said, "This is something that has been in place for several years, and to date, we have not received any calls or letters of concern for this service."
Troughton explained that the measure is intended to control health care costs. She added that doctors are not required to abide by the orders.
Troughton also noted that sharing medical information with medical groups is not illegal and falls under "patient, treatment and operations" guidelines of federal medical privacy rules.
Lynne Randolph, spokesperson for the Department of Managed Health Care, said the agency would review Blue Cross's letter.
Meanwhile, Byron Tucker, spokesperson for Insurance Commissioner Steve Poizner (R), said the letter is "on our radar now," adding that it "is the insurer's job to underwrite their policies," rather than doctors' responsibility (Girion, Los Angeles Times, 2/12).