AMA issues health insurer code of conduct

The document's principles are meant to protect patients and physicians from what the Association calls questionable insurance practices.

By Bob Cook — Posted June 1, 2010

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The American Medical Association has released a code of conduct for health insurers, calling on them to "adopt consistent corporate practices that will bring transparency and accountability to the multibillion-dollar health insurance industry."

The Health Insurer Code of Conduct Principles, released May 24 with the endorsement of 68 state and specialty medical societies, spells out standards for insurers' administrative and clinical processes. It covers topics, such as rescissions, premiums and corporate conduct, that have been the focus of lawmakers and others during the passage of health system reform.

It also addresses access to care, medical necessity, benefit management, physician profiling, administrative simplification and claims processing.

"The health insurance industry has a crisis of credibility," AMA President J. James Rohack, MD, said in a statement. "With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities."

Work began on the code well before health system reform. The AMA's House of Delegates, at its November 2008 Interim Meeting, passed a resolution to have the organization develop a health insurer code of conduct.

The AMA and the supporting societies on May 21 sent individual letters to chief executive officers of eight large private health plans -- Aetna, Cigna, Coventry Health Care, Health Net, Humana, Health Care Service Corp., UnitedHealth Group and WellPoint -- asking them to pledge commitment to their code. "Commitment to these fundamental principles will demonstrate your company's dedication to truly putting your patients first," the letter said.

America's Health Insurance Plans, the insurer trade group, and the BlueCross BlueShield Assn. also received copies.

The letter noted that it had been more than a decade since AHIP adopted its own Philosophy of Care, which called on insurers to adhere to "high standards of quality and professional ethics, and to the principle that patients come first." The AMA called insurers' record with that standard "questionable," and it said its own code "offers a unique opportunity for insurers to renew their commitment and earn the trust of patients and physicians."

A statement from AHIP spokesman Robert Zirkelbach did not directly address the AMA's code, instead pledging that "we will continue to work with policymakers and other health care stakeholders to improve the quality, safety and efficiency of our health care system."

"All stakeholders need to work together to reduce gaps in care and the continued variation in practice patterns that have been widely documented by leading health care organizations," Zirkelbach added.

The AMA said it will distribute a CD-ROM with resources to help physicians monitor insurer compliance with its code. The Health Insurer Code of Conduct Principles is online (link).

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