Facing a storm of criticism from nearly every quarter imaginable, Blue Cross of California abruptly stopped its practice of sending letters to physicians asking then to look for medical conditions that could be used to cancel patients' insurance coverage. The practice was halted one day after it was exposed by the Los Angeles Times in a February 12th article.

Revelations of Blue Cross's policy drew formal protests from medical associations, privacy and patients rights groups, and politicians. Calif. Gov. Arnold Schwarzenegger said the practice was "outrageous" and should be banned, stating it was akin to telling physicians to "rat out the patients and to give the patients' medical history to the insurance company so they have a reason to cancel the policy." He added it was "one more reason why it is so important to have comprehensive healthcare reform."

Sen. Hillary Clinton (D-NY), the Democratic presidential contender, said the Blue Cross effort was another "example of how insurance companies spend tens of billions of dollars a year figuring out how to avoid covering people with health insurance."

Shannon Troughton, a spokeswoman for Blue Cross parent WellPoint Inc., said the company had been sending as many as 1,000 letters a month for years and had received no complaints. Blue Cross sent physicians copies of insurance applications filled out by new patients, along with the letter advising them the company had a right to drop members who failed to disclose "material medical history." That could include "preexisting pregnancies."          The letter asked physicians to "immediately" report any discrepancies between their patients" medical condition and the information in the applications.

Other large health insurers, including UnitedHealth Group Inc. - which operates PacifiCare in California - Blue Shield of California and Health Net Inc., said they did ask doctors to look for or alert them to possible preexisting medical conditions. Margita Thompson, a spokeswoman for Health Net, said the company asks physicians for medical records when it suspects patients may have omitted preexisting conditions on applications.

"But the doctor is not asked to review the records at all," she said. "And we do not send the doctor a copy of the application for his review."

While the L.A. Times was developing the story, Blue Cross initially defended the practice. Troughton, the WellPoint spokeswoman, said the company believed the letters complied with State and federal privacy and health practice laws.

"It is our responsibility to assure that all members" records are accurate and up to date both for the benefit of our members and the providers in our HMO network," she said, adding that sending applications to physicians for review is an important tool to "ensure that it mirrors what is reflected in the physician's notes for that member."

But the day after the story ran, Blue Cross reversed itself. "Today we reached out to our provider partners and California regulators and determined this letter is no longer necessary and, in fact, was creating a misimpression and causing some members and providers undue concern."

"They don't have a right to contact someone that you hired to take care of your health and to release data about you without your permission," said Deborah Peel, a Texas physician who founded Patient Privacy Rights, a nonprofit advocacy organization. "What's the point of paying for insurance if they are going to look for every reason to deny what you think you paid for, which is access to services to help you?"

Source: Privacy Times

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