Health Insurers Must be Accountable

Dr. Christina Mayville
Dr. Christina Mayville

The American Medical Association (AMA) is considering a national health insurer code of conduct, calling on the U.S. health insurance industry to adopt consistent practices regarding costs, business transparency and the physician-patient relationship.

While health care providers – physicians, nurses, hospitals – adhere to strict professional and medical guidelines, no similar protocols exist for health insurers.

And although regulated to some extent like many industries, health insurers have had no meaningful selfregulation – an important business practice and one that a code of conduct ensures.

Why is this important? It is important because health insurers are the primary bridge between physicians and their patients, between hospitals and physicians, and between patients and hospitals. Health insurers should provide easy access to necessary health care. But they often are an obstacle.

In my practice of neurology, I frequently encounter situations which demonstrate the need for such a code of conduct. Recently a patient whom I’d seen regularly presented with a new neurological problem which did not seem related to the chronic condition for which he is routinely followed. .

If the recommended test had been approved, the subsequent emergency room visit, transfer via ambulance and additional, more costly testing would have been avoided. The patient would have been admitted to the hospital and had a routine, rather than emergency, neurological consultation and operation.

The AMA’s proposed code of conduct will lay out clear principles to be followed by health insurers, addressing medical and payment issues, monitoring and compliance frameworks, and restrictive practices that damage the physicianpatient relationship. It seeks to shine a light on any third party who influences the health care of a patient, ensuring that the physician provides that care – not a managed care company – and that no unauthorized changes are made without the knowledge of the physician and patient. Health care reform has stepped onto the stage in Washington. Much debate will take place about what needs to added and what needs to be fixed. Holding the health insurance industry accountable – to itself – is a strong starting point.

Dr. Christina Mayville is a

neurologist in Macon, Ga.

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