First Major Policy Shift By An HMO to Patient and Physician Complaints; Other HMOs Asked To Allow Practicing Doctors To Decide Medical Necessity

UnitedHealth‘s announcement that it will give doctors final say over what is medically necessary treatment — an indication that it essentially paid more for bureaucrats to cut costs than those bureaucrats have saved — is a sea change in industry policy, according to the co-author of a new book on the vices of HMO medicine. The story was first reported in the Dallas Morning News.

“This appears to be the first time an HMO has answered physician and consumer complaints about delivery of quality services with a major policy shift,” said consumer advocate Jamie Court, co-author of Making A Killing: HMOs and the Threat To Your Health(Common Courage Press, 1999). “With HMO liability an increasing reality, Wall Street is clearly forcing HMOs to compete on the basis of quality, not simply cost-cutting. It is an extraordinary announcement when the nation’s second largest health insurer heeds patients concerns about unnecessary intrusion by HMO bureaucrats and essentially admits that corporate bureaucrats cost more than they save. If practicing physicians at UnitedHealth will be making medical necessity decisions, then other companies will have to follow suit. Hopefully this is a genuine policy initiative not a marketing ploy.”

Court and Foundation for Taxpayer and Consumer Rights President Harvey Rosenfield will write executives at the nation’s other largest HMOs this week asking that they allow practicing physicians to make medical necessity decisions.

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