This was emailed to me by a friend in the insurance world. It has links but I can't seem to up load them. email if you want it forwarded.
AMA offers code of conduct for insurers
The American Medical Association released a set of 10 health insurer code of conduct principles designed to increase transparency and accountability.
Among the principles are subjecting a decision to cancel a person's coverage to independent, outside review; spending the vast majority of a premium dollar on direct medical care;
and mandating that only a doctor can make a decision to deny care on the grounds that it is not "medically necessary." The code has been endorsed by 68 state and specialty medical societies.
Seeking their compliance, the AMA sent letters to the country's eight largest insurers, namely Aetna, Cigna, Coventry Health Care, Health Net, Humana, Health Care Service, UnitedHealth and WellPoint.
HealthLeaders (5/25/10), Modern Healthcare (free reg. req'd) (5/24/10), Health Data Management (5/24/10), PR Newswire-U.S. Newswire (5/24/10), Read the principles (5/24/10), Humana Spotlight, Managed Care Companies
Posted by lymewreck36 (Member # 4395) on :
Is this really going to happen. Would that stop, for good, the doctor bashing of llmd's?
Mary
Posted by Renee K (Member # 21220) on :
Ah, there is a loophole here. What Doctor is going to make the decision? The HMOs had a medical director who was a Physician and made the final determinations on approval or denial of care, the participating PCP had to abide by that decision.
Also note outside review...independent, not your own doctor...more than likely would use standard approved guidelines to determine what care "should" be given.