Blue Cross Wants Data, But Breaks Doctor-Patient Confidentiality

Blue Cross, the largest health insurer of its kind in California, has asked physicians across the state to report any “material medical history” their patients didn’t mention when they applied for insurance, including “pre-existing pregnancies”, the Los Angeles Times reports. That request however has raised a lot of questions on whether disclosing that information would violate the doctor – patient confidentiality policy.

As it appears, physicians are not ready yet to respond to Blue Cross’ request: “We’re outraged that they are asking doctors to violate the sacred trust of patients to rat them out of medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality,” Dr. Richard Frankenstein, president of the California Medical Association, said to the same newspaper.

At the same time, this could send a message to the patients, who will be reluctant to telling their doctors information regarding their health that might compromise their insurance policy. But the Blue Cross is determined to discover the “health history discrepancies” by having acces to information such as: health history questionnaire completed at the member’s initial visit to the medical group; pre-existing pregnancies; elective and emergency surgeries performed; member requests for specialty referrals outside the medical group and within the medical group; claims from outside providers requesting payment and first year hospitalizations.

Despite the opposition, the Blue Cross is determined to continue its campaign and identify members who may not have been honest in their initial application. The Blue Cross is just one of the insurers that have had to deal with situations of canceling coverage after failing to check the applications first. Last year alone, the company was fined $1 million for allegedly inappropriately canceling policies. “Blue Cross feels it is our responsibility to assure all records are accurate and up to date for HMO providers,” said Shannon Troughton, spokesman for WellPoint, which owns the Blue Cross.