AMA resolution would hold managed care staff liable

Delegates say insurance company workers who interfere with claims payments should be punished.

By Robert Kazel, AMNews staff. July 7, 2003.

Chicago -- Individual employees of managed care organizations, not just the health plans themselves, should be held liable if they obstruct claims payments to physicians, a new AMA policy suggests.

A resolution adopted in June by the Association's House of Delegates says the AMA will push for employees of managed care plans and insurance companies to be subject to "heavy penalties" if claims payments are not handled properly -- for example, if reimbursements are illegally denied or delayed. Previous AMA policy identified only the plans as targets for penalties.

The policy was one of several actions by delegates that took a firm stance on payers, attempting to address some of the headaches doctors face in their dealings with plans.

"Bring it on," Thomas Whalen, MD, a pediatric surgeon and delegate from New Brunswick, N.J., said of holding insurance workers liable. "These [employees] just shield themselves under the corporate umbrella. The more we can do ... across the board, the better it would be."

Doctors often run into health plan employees suffering from "Friday afternoon clean-desk syndrome," said J. James Rohack, MD, a cardiologist in Temple, Texas, and an AMA board member. Claims appear to "magically disappear and are lost" in too many cases, he said.

But talking about holding insurance workers liable has a "punitive tenor" to it that overlooks the point that the great majority of patient claims are processed efficiently, said Susan Pisano, spokeswoman for the American Assn. of Health Plans.