AMA Scolds Insurers, Calls For Stronger Doctors’ Voice
Escalating its struggle for control over medical decision-making, the American Medical Assn. on Monday harshly accused the insurance industry of keeping consumers “in the dark” on details of their health policies and called on Congress to protect patients by guaranteeing doctors a strong voice in treatment decisions.
In a full page ad in the Washington Post headlined: “What You Don’t Know CAN Hurt You,” the AMA said that its proposal would “require insurance companies to give you all the information you need before you join a health plan. They’ll have to tell you what is and isn’t covered . . . (and) what sort of approval process you have to go through to get the care you need.”
Without such reforms, insurers will “take over the examining room,” said Dr. Lonnie R. Bristow, AMA board chairman.
In promoting the “Patient Protection Act,” the AMA sought to strike a populist note as a consumer champion. But AMA leaders conceded that the proposal might just as accurately be called the “Physician Protection Act.”
“Well, you bet we want protections for doctors--because doctors are one-half of the doctor-patient relationship,” Bristow said.
Increasingly, managed care networks--rather than physicians--are deciding for patients what services are allowable and which physicians they may see. Managed care generally refers to health plans that impose varying degrees of restrictions on doctors and patients as a way to control costs.
Bristow, of San Pablo, Calif., said that the AMA also wants Congress to require insurers to reveal to doctors “exactly who is reviewing their work,” putting an end to what he called “the KGB-like secrecy.” He singled out for criticism the Big Five insurers that dominate the managed care industry: Aetna, Prudential, Cigna, Metropolitan Life and Travelers.
Barbara B. Hill, vice president for health policy of the Prudential Insurance Co. of America, rejected the AMA’s charges and said that the nation’s largest doctors organization was acting primarily out of self-interest.
