Doctors hesitate to suggest treatment options that insurers won't cover

But an organization for health plans said a study on the issue is flawed because it deals with perceived coverage restrictions.

By Damon Adams, AMNews staff. July 28, 2003.

Doctors may be doing more than a disservice to patients when they fail to mention treatments not covered by insurance. They may be violating medical ethics and eroding patient trust as well.

Furthermore, they could be held liable for the omissions, which, in a recent study, almost one in three doctors admitted making. They said there were occasions when they didn't inform patients about useful medical services because of health plan rules.

Physicians and ethicists said withholding services not covered by insurance makes doctors seem more concerned with costs than care.

"It's outrageous. Not only from the standpoint of medical ethics but also from a point of public relations. That's exactly what the patients are worried about -- that you're an advocate for the insurance company," said Michael Grodin, MD, director of the medical ethics program at Boston University School of Medicine and professor of health law at the university's School of Public Health.

"In the role of caring for the patient, you have to think clearly and solely for the benefit of the patient," he said. "Whether they are covered is not the issue. It's what's best for the patient. Then you try to figure out how to get it covered."

The study is the third in four months to raise questions about the physician-patient relationship.

A study in the April American Journal of Public Health found that physicians are too busy to give preventive care to their patients. The study said doctors would need 7.4 hours a day to provide all the preventive care recommended by a U.S. task force, and advocated using nurse practitioners and others to help with prevention.