Health Insurer Code of Conduct
At the 2008 AMA Interim Meeting, the New York Delegation’s Resolution 823, “Health Insurance Code of Conduct,” was unanimously adopted by the AMA House of Delegates. This resolution directed for the AMA to:
- develop a Health Insurer Code of Conduct (“Code of Conduct”) that sets forth clear and concise principles for health insurers to follow when setting and administering medical care and payment policies;
- seek concurrence among health insurers in complying with the Code of Conduct; and
- develop a mechanism to monitor compliance with this Code of Conduct.
In response to resolution 823, the AMA has developed the 10 explicitly defined principles governing both clinical and business operations of health plans which the medical profession believes to be critical to enable an efficient, patient-centered health care system.
The Code of Conduct is not intended to, and does not convey legal advice. Users of the Code of Conduct should always consult their own legal counsel when considering a legal arrangement.
Access the complete AMA Health Insurer Code of Conduct. The AMA encourages all health insurers and other third-party payers to pledge to conduct business in adherence with the Health Insurer Code of Conduct. By making this commitment, they will do their part to bring consistency, accountability and transparency to the health care industry.
Pledge your commitment to abide by or support the AMA Code of Conduct Principles
Patient protection and affordable care act and the AMA health insurer Code of Conduct Principles
A number of the Patient Protection and Affordable Care Act’s (PPACA) provisions impose substantial obligations on health insurers and group health plans. Many of these obligations address aspects of the AMA’s Code of Conduct Principles. The AMA has created a document that sets forth those portions of the PPACA that relate to the AMA’s Code of Conduct Principles. While the PPACA provides welcome relief from a number of troubling practices, it also provides a tremendous opportunity for health insurers to commit to a code of conduct designed to maximize the clinical and business integrity of all their dealings.
To help physicians and their advocates hold health insurers accountable to the fair business practices that the code of conduct addresses, the AMA offers this unique resource to assist you in monitoring health insurer compliance with the AMA's Health Insurer Code of Conduct Principles. Comprehensive and empowering, this resource includes:
- excerpts from the National Managed Care Contract, which is based on the most physician-favorable managed care laws from around the country
- managed care legislative strategies and model bills
- settlement provisions that certain health insurers have agreed to abide by
- information on health insurer fines and CEO compensation
- physician practice resources that empower physicians in managed care interactions, such as claims processing, managed care contracting, and contesting physician profiling and tiering results
Help promote and enforce the AMA Code of Conduct
- Medical associations can encourage additional health insurers to comply with the AMA Code of Conduct principles by sending a copy of the co-signed letter that was sent to the major national health insurers, America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA).
- Letter to AHIP
- Letter to BCBSA
Health insurer financial information and fines
Health insurer state fines
The AMA has compiled a resource that lists the fines health insurers have incurred in each state and the reasons for the fines. This resource underscores the importance of reporting unfair payer practices.
Health insurer financials
The AMA has compiled a resource that highlights health insurer SEC filing data since 2006. This resource provides information based on company filings for the seven largest national publicly traded health insurers: Aetna, CIGNA, Coventry, Health Net, Humana, UnitedHealthcare and WellPoint/Anthem.
Health insurer CEO compensation
The AMA has compiled a resource that highlights health insurer Securities and Exchange Commission (SEC) filing data, including CEO compensation since 2006. This resource provides information based on company filings for the seven largest national publicly traded health insurers: Aetna, CIGNA, Coventry, Health Net, Humana, UnitedHealthcare and WellPoint/Anthem.