HMO Will End Doctor Gag Clauses
A leading health insurer is trying to quell a growing chorus of critics who accuse managed-care plans of padding their profits by gagging doctors from telling their patients about more expensive treatment options.
US Healthcare, a health maintenance organization with more than 2.2 million members, said Friday that it is replacing a clause that restricted what doctors could say with a clause that protects their freedom of speech.
The Blue Bell, Pa.-based HMO was responding to criticism from the American Medical Assn. and state legislators in California, New York, New Jersey and elsewhere.
These critics say several HMOs have gone so far as to prohibit doctors from saying anything bad about the HMO. Some even prohibit the doctor from telling the patients about treatment options unless they are preapproved by the HMO, the AMA said.
These gag clauses unethically interfere in the doctor-patient relationship, the AMA has said.
US Healthcare, which had been singled out for firing at least one doctor who complained about its gag clause, denied Friday that anything in its contracts has ever been intended to restrict doctor-patient communications.
“This enhanced provision lays to rest any issue regarding allegedly inappropriate restrictions on physician-patient communications, while still protecting competitively sensitive information and confidential patient records,” said David Simon, US Healthcare’s top legal counsel. “We hope and anticipate that other health plans will follow our lead and adopt similar freedom-of-speech provisions in their agreements.”
The AMA called US Healthcare’s move a good first step.
“We will want to make sure it does in fact eliminate gag clauses, but on the assumption it does, we consider it to be very good news for doctors and their patients,” AMA President Dr. Lonnie Bristow said.
“It allows doctors to carry out their medical obligation to provide the patient the best information on the condition they have and the various treatment options,” he said.
