Patients who seek emergency services when they reasonably believe they need immediate medical attention should not be subject to retrospective review or denial of care or reimbursement. Gag clauses and gag practices seek to prevent physicians from discussing with their patients plan or treatment options or disclosing financial incentives that may affect the patient's treatment. These clauses and practices strike at the heart of the patient-physician relationship, can create real conflicts between patients and their physicians, and encourage physicians to breach their fiduciary duties to their patients. Plans and issuers should have to identify benefits offered-including covered benefits, benefit limits, coverage exclusions, prior authorization rules, appeals procedures, and other basic information. They should also have to give patients access to additional pertinent information, such as drug formulary restrictions.
Patients deserve to know exactly what they are paying for.
The AMA urges you, as Conferees, to take advantage of this historic opportunity and responsibility to protect the patients of this nation and produce a meaningful and effective patient protection conference report that includes all of the essential principles listed above. The American people have repeatedly indicated that they want their elected leaders to back a strong patient protection bill, and as their physicians, we strongly reiterate their concerns. Copyright 1995-2001 American Medical Association. All rights reserved.