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At their June Board meeting, the AMCNO board of
directors endorsed the AMA’s Code of Conduct for Health Insurers. The AMCNO
has also listed our name as a supporter of the code on the AMA web site.
Organized medicine has called on all U.S. health insurance companies to
adopt consistent corporate practices that will bring transparency and
accountability to the multibillion-dollar health insurance industry. The AMA
has sent letters to the nation’s eight largest health insurers seeking their
pledge to comply with the National Health Insurer Code of Conduct
Principles.
The code sets forth 10 principles that govern both the
business and clinical aspects of health plans. By following these
principles, which were also endorsed by 68 state and specialty medical
societies, health insurers can help create a more efficient,
patient-centered health system. The code advocates for:
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Prohibition of cancellation or rescissions of policies
because of mistakes on an application, or because a policyholder got
sick or injured, or because insurer employees or contractors get bonuses
for rescissions;
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Clear and transparent access to medical care, meaning
benefits that are available to enrollees on a timely and geographically
accessible basis at the preferred, in-network rate, and easily
accessible physician directories that mark those doctors who are
out-of-network or only available on a tiered plan;
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Fair and transparent pricing and accounting of health
insurance premiums, with most of the money spent on care;
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Respectful relations by plans with their enrollees,
physicians and other partners, including fair contracting, protection of
patients’ medical information and “appropriate deference” to the
physician’s skill and judgment;
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Clear information on benefit restrictions to the patient
and the physician, with benefits based on clinically appropriate medical
guidelines;
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Medically necessary care defined by what a prudent
physician would provide in a certain situation, rather than a definition
for the economic benefit of the health plan;
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Elimination of complexity and confusion from health plan
processes and communications;
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Physician profiling systems that use relevant data to
focus on quality of care, not on reducing the cost of care;
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Health insurers to conduct their business with the
highest levels of corporate citizenship, including complying with the
letter of all laws affecting clinical and business operations;
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Health insurers to pay claims accurately and on time,
and to provide explanations of how each claim was handled, as well as
providing fee schedules, claim edits and pay policies that are disclosed
and easily available.
To view the AMA Code of Conduct document go to:
http://www.ama-assn.org/ama1/pub/upload/mm/368/coc-principles.pdf
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