blog.bioethics.net

Syndiated Columnist Kate Scannell on Lying to Insurance Companies

Kate Scannell is a great columnist - she does her homework and writes with verve about social issues. And she reads AJOB; that alone makes her cool. So we were incredibly proud to read her most recent column, based entirely on the new articles in our journal about lying to insurance companies. She even did her own little "mini-study" to confirm the findings of the authors:

In an article published in the current issue of The American Journal of Bioethics, researchers examined the willingness of the public and physicians to support deception of insurance companies for the purpose of obtaining health care services. The researchers asked over 1,600 physicians and 700 public members (drawn from a pool of prospective jurors) what the doctor should do in similar scenarios.

The researchers found that 26 percent of the public sample and 11 percent of surveyed physicians chose deception of the insurance company as the proper response.

Mine is an informal and unscientific poll, but I had the opportunity to ask 22 physicians about their response to the study's findings. No one was surprised that some physicians and public citizens supported deception of insurance companies in the service of obtaining necessary patient care, but all were surprised that the reported percentages were so low. Nearly everyone believed that the majority of physicians at some time or   other had "stretched the truth"or "coaxed a patient" or "caved in to a patient's demands" to misrepresent facts in order to satisfy the insurance company's pre-qualification criteria for obtaining costly drugs or tests.

In both circumstances, health care costs may be driven upwards if patients are inadequately treated or diagnosed, and if doctors and patients spend too much time making requests and appeals to insurance companies. Additionally, the medical profession may find its reputation undermined when an insurance company administrator   can trump doctors' medical decision-making and determine what constitutes necessary medical care.