34950 Date Palm Dr, Cathedral City, CA


A July 8, 2003 Associated Press report that appeared on the MSN as well as the InteliHealth web sites reported on a study revealing that physicians withhold providing heath care treatment options to their patients based on the types of insurance policies they have. The investigation demonstrates nearly one out of three physicians claims withholding information from patients about beneficial medical services which are not covered by their health insurance companies. The writers of the study say their work supplies the first solid evidence that insurance coverage limitations imposed by managed care is having a profound effect on doctor-patient recommendations.

Matthew K. Wynia, director of the Institute for Ethics at the American Medical Association and lead author of the article being published in the journal Health Affairs says, "People are not getting the whole story". Wynia and his colleagues surveyed 700 physicians and asked how frequently they had decided not to provide a "useful service to a patient because of health plan rules." Final results of the research, which was conducted in 1998 and 1999, were analyzed in the July 9, 2003 edition of the medical journal "Health Affairs." The results showed 42 percent said never, and 27 percent said rarely. But surprisingly, 23 percent said "sometimes," and 8 percent said "frequently" or "very often."

The articles mentioned that while ethics codes require doctors to disclose "medically appropriate treatment alternatives, despite cost, a lot of medical doctors are nervous about explaining medically indicated ... care that is not covered" by insurance. William S. Custer, a professor in the Insurance Department at Georgia State University, said physicians have always factored a patient's ability to afford treatment into their medical advice. He notes, "Doctors have done that ever since the days of Marcus Welby. They understood what the patient could afford and offered services that would fit what they could afford."

Several years ago, some managed care companies barred doctors from discussing medical options not covered by the health plan. Those rules, known as "gag clauses," were abandoned by most companies because of public outcry. Additionally, many states passed laws banning gag clauses from insurance policies and contracts.

Back to Articles List