Deceptive Health Insurance Practices
Is it ethical for doctors to bend the truth in order to get an insurance company to pay for medical treatment? According to this article, most doctors do. A survey has shown that 58% of doctors say that they would be willing to give an insurance company "deliberately deceptive documentation" to influence the company's decision to approve surgery or other treatment for a life-threatening illness.
These doctors believe that if they did not lie, their patients would receive sub-standard health care. Insurance companies are continually looking for ways to reduce their costs, and the most common way is to second-guess the doctors' opinions or to approve the minimum treatments necessary. This has created a crisis in American medicine in which doctors feel they must be dishonest with the insurance companies in order to be the "good guy" to their patients.
Does the end justify the mean? After all, these doctors seem to have a good reason for lying. They are trying to help someone, right? But it does not make it morally and ethically right. Lying is wrong, no matter what the reason is. Even though saving someone's life seems to be a valid reason for bending the truth, it does not solve the problem. It is unethical for a doctor to lie, even to an insurance company. Although
HMO's and insurance companies need to be dealt with, lying is not the way to defeat them. You should not lie to "beat the system." It solves nothing. Lying is a quick fix. It may work on a case-to-case basis, but health care reform is the only permanent solution.
While we can condemn doctors for being untruthful, we also have to look at the flip side -- HMO's and other insurance companies who are trying to cut back costs, approving the least expensive treatments and sometimes denying those claims that have real merit. These companies do breed an environment where it is difficult for doctors to be completely honest. Doctors are supposed to be looking after the interests of their patients, and they sometimes see lying as the only way to skirt the policies of some HMO's.
The author takes the position that it is morally and ethically wrong for doctors to lie to insurance companies. However, in the current health system, dishonest pays.
At first, I believed that a patient should have the say so and get what they demand. I didn’t feel sympathetic for the health care provider one bit. I was able to look through the eyes of a physician and see the trials that they have to go through. It is not easy making the decisions that they have to make. There job is based on decisions, and most of it is the patient’s. “There will certainly be times when I will be faced with a request from a patient or patient’s representative that I will personally find morally difficult, but one that is still legally and ethically acceptable. must be very difficult to work in an area with little control over what you want to do.” (Bradley 1). Even though I do not fully understand a health care providers everyday role, I do know that they are faced with painful options. I personally feel that I can not work in this field for that exact reason. Health care providers play an extremely important role in our society, and others need to look upon
Based on them, we can definitely eliminate options (c) and (d). Option (c) is against the principle of veracity and informed consent because the doctor was lying and hiding the information about the patient’s health that the patient was supposed to know. Option (d) is morally incorrect because the patient is lied to and the surgeon is not penalized. Option (b) does abide by the principle of veracity, but is against rationality because it sets negative example for the community that the doctors can be forgiven for their mistakes. Moreover, it does not abide by stewardship because the surgeon is taking advantage of being a doctor to conceal the truth. Consequently, the morally correct decision would be the option (a) because it abides by the principles of veracity and informed consent as the responsibility of disclosing the truth to the patient is fulfilled. Moreover, considering the rationality and stewardship, it will set an example for all the doctors that incomplete disclosure of information to the patient is unacceptable and the doctors should not take advantage of their importance in the
One of the biggest contributors to health care costs that I have seen during my time in the healthcare industry is insurance fraud. One example of such fraud came about two months ago. I was taking a phone call from a provider that was upset that one of their claims had denied even though all of their previous claims had been paid. In researching with a partner plan it was determined that the claim denied because this medical provid...
To conclude, I think that physicians should tell the truth directly to the patient, even against family requests. Yes, there are some exceptions, of which are associated to the patients’ age, disease, and religious beliefs that makes doctors respect family wishes. Ruiping Fan and Benfu Li say that Confucian Chinese practice encourage doctors to hide the truth from the patient if his or her family thinks that it should be hidden. They say that it “…is most important for one [patient] to know everything and make medical decisions by oneself, but to have the love and interdependence of family members” (pg. 71). In agreement, a patient is entitled to know his or her condition, despite family wishes, but should also receive the support and care from their family.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
People will at least once, probably more, have to deal with insurance companies. For many, this typically results in a long, and heated struggle of figuring out what is covered, and what is not. It is also usually accompanied by negotiating something to be covered, and giving justification of why it should. Almost anyone will agree that handling insurance companies is as bad as pulling teeth. This is said to be true even when the medical diagnoses are concrete in the social construct of society. Many insurances will not cover things as dyer as cancer. If this is so commonly believed, imagine how it is for the illness that are not concrete; illnesses such as bipolar disorder, post-traumatic stress disorder (PTSD), and schizophrenia. All phrases that are commonly heard in media, but widely accepted as untrue illnesses, or educated
Medical ethics could be so many different thing mostly bad.There's so many stories about medical ethics this this story about this girl. At the age of 13 she was diagnosed with a rare and fated type of cancer.The survived and was cleaned that didn't have cancer. Then 10 years later she fought for her life again, she had sergey. After the Surgery there was no where no sign of the cancer. There years later she married and she became pregnant because of her health history she went to a clinic so they could watch her pregnancy.She had to go back to the clinic for having a lung tumor. She want to be in the best health, surgery was not an option. Her baby was too small to be born yet ,” meaning too premature.” (Thornton )She wanted to keep treating her cancer but, the doctors said that should wait until 28 weeks.She waited and the doctors she it was too dangerous and they wouldn’t help.So they want to cort.The court made it distion and at time is was very ill. The court order a surguy but the doctor said that if she goes into surgery she might not make it. She refused, but the doctors could not refused the courts orders. She was rolled into the surgery room. she made it into through the surgery, but two days later she died. She ...
One of the most complex, ever-changing careers is the medical field. Physicians are not only faced with medical challenges, but also with ethical ones. In “Respect for Patients, Physicians, and the Truth”, by Susan Cullen and Margaret Klein, they discuss to great extent the complicated dilemmas physicians encounter during their practice. In their publication, Cullen and Klein discuss the pros and cons of disclosing the medical diagnosis (identifying the nature or cause of the disease), and the prognosis (the end result after treating the condition). But this subject is not easily regulated nor are there guidelines to follow. One example that clearly illustrates the ambiguity of the subject is when a patient is diagnosed with a serious, life-threatening
Not only do health care providers have an ethical implication to care for patients, they also have a legal obligation and responsibility to care for the patient. According to the Collins English dictionary, a duty of care is ‘the legal obligation to safeguard others from harm while they are in your care, using your services or exposed to your activities’. The legal definition takes it further by making it a requirement that a person act towards others and the public with watchfulness, attention, caution and prudence which a reasonable person in the circumstances would use. If a person’s actions fail to meet the required standard, then the acts are considered negligent (Hill and Hill, 2002). If a professional fails to abide to the standard of practice for their practice in regards to their peers, they leave themselves open to criticisms or claims of breach of duty of care, and possibly negligence. Negligence is comprised of five elements: (1) duty, (2) breach, (3) cause in fact, (4) proximate cause, and (5) harm. Duty is defined as the implied duty to care/provide service, breach is the lack thereof, cause in fact must be proven by plaintiff, proximate cause means that only the harm caused directly causative to the breach itself and not additional causation, and harm is the specific injury resultant from the breach.
Truth in medicine is a big discussion among many medical professionals about how doctors handle the truth. Truth to a patient can be presented in many ways and different doctors have different ways of handling it. Many often believe that patient’s being fully aware of their health; such as a bad diagnosis, could lead to depression compared to not knowing the diagnosis. In today’s society doctor’s are expected to deliver patient’s the whole truth in order for patients to actively make their own health decisions. Shelly K. Schwartz discusses the truth in her essay, Is It Ever Ok to Lie to Patients?. Schwartz argument is that patients should be told the truth about their health and presented and addressed in a way most comfortable to the patient.
From the utilitarian’s side, lying might be a good choice, since it brings more happiness to the patient. In fact, truthfulness can actually do harm. Patient’s health situation becomes worst when he knows that he have a serious disease. He will become depressed and might suffer from psychological disorders like anxiety which reduces the efficiency of healing. For example people suffering from Nosophobia , Hypochondriasis or Nosocomephobia: “which are an irrational fear of contracting a disease, a fear of hospitals or refers to excessive preoccupancy or worry about having a serious illness ” are most likely to be affected by truth of having a serious ill or undergoing a dangerous medical operation. That’s why some doctors use lying as way of curing; they don’t try only to heal the disease, but also they make sure that the patient is in his most relaxed state, in order not to harm him. Roger Higgs in his article “On telling patients the truth” argues that doctors have no exemption from telling the truth. I other words, when a doctor lies he needs to give justifications. For the maleficence argument, Higgs argues that the truth actually does not harm; but the way the doctor tells the truth a...
Garrett, T. M., Baillie, H. W., & Garrett, R. M. (2010). Health care ethics: Principles and problems (5thed.). Upper Saddle River, NJ: Prentice Hall.
The most common areas of clinical practice where truth-telling and deception become an ethical dilemma are critical care, cancer and palliative care, mental health and general nursing practice (Tuckett, 2004). Other areas where it can raise potential ethical concerns are in placebo therapy, disclosure of human immunodeficiency virus and informed consent (Tuckett, 2004). Truth-telling is also an act of exchanging moral agents (patients, relatives, nurses) with their sets of values and norms, which in turn are derived from culture, personal and religious beliefs, and traditions (Dossa, 2010). For this reason, the issue of truth-telling is not only approached differently in the various clinical settings but also in different countries, cultures and religions (Kazdaglis et al., 2010). For example, in the United States of America (USA), England, Canada and Finland, the majority of patients are told of their diagnosis (Kazdaglis et al., 2010). Conversely, in Japan, family members play a major role in the decision of ...
The American Medical Association (AMA) developed a Code of Medical Ethics which includes: the patient has a right to obtain and discuss health information related to benefits, risks, and costs of treatment alternatives; patient’s can make decisions pertaining to healthcare suggested by the physician; the patient has the right to courtesy, respect, dignity, and attention to healthcare needs in a timely manner; and the patient has a right to confidentially, continuity, and adequate health care. (emedicinehealth, 2011). Communicating openly and honestly between the patient and doctor will allow both parties to make decisions to properly take care of needs.
Consequently, it can be assumed that doctors might tend to avoid such a confession in order to maintain their image of being a “good doctor” (J.Shahidi). Not being a good doctor may eventually lead to doctor’s loss of business and as a result physicians may tend to hide the truth even if it opposes patient autonomy