AMA's code of conduct helps ensure greater transparency and accountability from health insurers

The American Medical Association (AMA) today released its Health Insurer Code of Conduct Principles and 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.

"Health insurers should provide access to necessary health care, protect the patient-physician relationship and accurately process medical claims, but too often they are an obstacle," said AMA President J. James Rohack, M.D. "The new Health Insurer Code of Conduct Principles will help protect patients and physicians from questionable insurance practices by holding the health insurance industry accountable."

The code of conduct developed by the AMA, and endorsed by 68 state and specialty medical societies, contains 10 clear principles critical to an efficient, patient-centered health care system. The principles shine light on health insurer practices that influence the health care of patients, including cancellation of coverage, medical services spending, access to care, fair contracting and patient confidentiality, medical necessity, benefit management, administrative simplification, physician profiling, corporate integrity and claims processing.

"Commitment to these fundamental principles will demonstrate a health insurer's dedication to truly putting patients first," said Dr. Rohack.

It has been 15 years since the health insurers' trade association adopted a Philosophy of Care, which pledged insurers to "high standards of quality and professional ethics, and to the principle that patients come first." The insurance industry's record of compliance with its standards has been questionable. The AMA's code of conduct offers a unique opportunity for insurers to renew their commitment and earn the trust of patients and physicians.

"The health insurance industry has a crisis of credibility," said Dr Rohack. "With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities."

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. It will widely distribute a CD-ROM with resources to help physicians monitor insurer compliance with the code.  The CD-ROM will include:

• Relevant provisions of federal health reform legislation.
• Relevant state managed care laws available through the AMA's National Managed Care Contract.
• Model legislative bills available through the AMA's Advocacy Resource Center.
• Regulatory fines, financial information and CEO compensation for the largest national health insurers.
• Details on national legal settlements against health insurers.
• Instructions for filing an online complaint through the AMA's Health Insurer Complaint Form.

The AMA's Practice Management Center also has resources available to physicians seeking help addressing disputes with health insurers who do not abide by the Health Insurer Code of Conduct Principles.