Bad Medicine: Is Your Insurance Company Hazardous to Your Health?

Infuriated by a deteriorating economy and blatant abuse of American taxpayers, the public is taking a strong stand to prevent banking executives from getting away with fiscal robbery. What many have failed to realize is that another industry - the health insurance industry - is getting away with murder, perhaps literally, by putting their bottom lines above your welfare, and this time it could be hazardous to your health.

Across the health care community from doctors to pharmaceutical companies to hospital organizations, steps have been taken to implement ethical standards. Codes of conduct are hardly a new idea. Most are self-imposed by professional organizations or trade groups on their members, often in an effort to voluntarily level up their members' general behavior, especially in the wake of legal or political scrutiny. For example, the pharmaceutical industry substantially revised its code governing interactions with health care professionals after public and professional criticism. Managed care organizations, however, are the only remaining hold-outs that have not adopted a Code of Conduct, leaving them highly unsupervised. Sadly, the very companies Americans often think help pay their bills are undercutting the quality of American health care in their pursuit of a fatter bottom line.

The game works like this_ Health insurers' profits increase as outlays for patient costs decrease. One such way to keep patient costs down is by prescribing generic drugs over name-brand drugs. In a practice known as drug switching, patients are switched from more expensive, name-brand drugs to generics, even if the name-brand drug was working and the patient experienced no negative side effects.

Managed care companies go to great lengths to make sure the switch appears innocent - a doctor is trying to help a patient reduce his or her medical expenses, and therefore recommends the generic. However, behind the closed doors of invite-only dinners and receptions hosted by managed care organizations, many doctors are lured into drug switching programs that offer attractive fiscal incentives, and there is no mechanism in place to regulate these practices.

Doctors are paying the price as well. In a survey done by the Toledo Blade last year among Ohio doctors, ninety-five percent of respondents said insurers interfered with decisions about prescriptions, 91 percent with testing, 74 percent with referrals, and 69 percent with hospitalization decisions. Eighty-six percent said interference compromised patient care, 76 percent said it adversely affected their patients, and 65 percent said they were unable to successfully protest denials. Most shockingly, 14 percent believed interference from an insurer had contributed to the death or serious injury of a patient.

This prompted a response from our now President:

"I am deeply troubled by The Blade's report of how insurance companies, not doctors and nurses, are making decisions about patient care," said Senator Barack Obama in a statement to The Blade. "Medical decisions should be made based on what's good for your health, not what's good for an insurance company's bottom line."

As managed care organizations seek to maximize profits and survive the economic downturn, the public can likely expect increasing use of cost-driven practices. These aggressive tactics must stop, and a comprehensive Health Insurer Code of Conduct must be implemented by which managed care organizations agree to abide by ethical standards such as transparency, clinical autonomy and, most importantly, patient safety and welfare.

The best Rx for every American is access to quality health care and medicine. It's time to ensure the health insurance industry puts your safety before profits.

For more information about the National Health Insurer Code of Conduct go to: www.insurepatientaccess.org.

Fox News Health Tips:

  • Know your medicines. Talk to your doctor about your prescriptions. Are they generics or brand names? What are they supposed to do? Are there less-expensive options? What are the risks and benefits of taking the drug?
  • Be on guard. If anyone wants to switch your prescription, ask why. Will the new drug interact with existing medications?
  • Appeal. With your doctor's help, use your health plan's appeals process to seek coverage for your desired medication.