Health Law

Physicians Called Upon to Identify Patients with Pre-Existing Conditions

By Todd A. Rodriguez

According to an article in the Los Angeles Times, a dispute is brewing in California over what one insurer is calling an “outreach effort” but others are calling an attempt to pit physicians against their patients. Specifically, Blue Cross of California has sent letters to physicians with a copy of patient insurance coverage applications, asking the physicians to identify patients who had pre-existing conditions at the time insurance coverage was extended to them. Presumably Blue Cross of California would use the information to rescind coverage for patients deemed to have pre-existing conditions. While Blue Cross of California says physician participation in the survey is voluntary, many physicians are concerned that enlisting physicians as moles in the effort could cause patients to withhold critical clinical information from their physicians. While HIPAA would likely permit the disclosure of this information, physicians considering making such disclosures should also check their participation contracts carefully to determine whether they have any duty to provide the data to an insurer.

Full post as published by Physician Law on February 18, 2008 (boomark / email).