I wrote earlier this week about some “fun” my wife and I are having with our health insurer.
It seems that Aetna might not be the only health insurer behaving badly. A post on CAHwyGuy’s Livejournal directs readers to an article in the Los Angeles Times regarding another insurer’s antics:
Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose “material medical history,” including “pre-existing pregnancies.”
“Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately,” the letters say.
BC points out that legislation and contract language permits doctors to disclose medical information about patients to their insurers. Doctors rebut by pointing out that patients may become reluctant to point out talk about their medical history if their physicians are going to be obliged to rat them out.
I know that some consumer-advocacy-minded folks would invoke a discussion on just how much preexisting conditions clauses suck. I’m somewhat cursed on that point by being able to see both sides of the issue, and I personally believe it’s one aspect of the larger question of “what are we going to do about health care in this country?”
Tabling that…I’m going to treat this story as yet another example of how my industry sometimes just doesn’t get it when it comes to customer and government relations.
Given that non-ERISA-governed health plans can and frequently do have pre-existing condition clauses, I agree with the idea that consumers with health issues may be tempted to misrepresent themselves on their insurance applications. And, if pricing doesn’t contemplate coverage of pre-existing conditions, it’s understandable that an insurer might want to enforce that language, to reduce pressure on rate adequacy.
But asking doctors to proactively tattle on their patients? Come on! Even presuming it is legal…it just doesn’t pass the “smell test”. If there’s a concern about misrepresentation on a particular insured’s app, I’ve got to believe that there are other ways to check up on that.