US HHS Warns HMOs On Treatment Option Gags

The US Department of Health and Human Services has told over 300 health maintenance organizations nationwide that HMOs and other health plans may not limit what doctors tell Medicare patients about treatment options. Federal health officials plan a similar policy for HMOs serving Medicaid patients, the New York Times notes.

Additionally, Congress is soon to consider a bill to ban these limits in private insurance as well as government programs. Doctors have said these gag clauses discourage them from telling patients about treatment options not covered by HMOs; these other options often carry expensive price tags. Because of last year's public debate over gag clauses, some HMOs have already dropped or modified them.

The HHS statement said Medicare HMO patients are entitled to all benefits available in the standard Medicare program, one of which was advice from doctors on "medically necessary treatment options." Any contract which limits a doctor's ability to advise a Medicare beneficiary is a violation of the federal Medicare law. A doctor caring for a Medicare patient "may not be limited in counseling or advising the beneficiary" about treatment options that may be appropriate for the patient's condition or disease; contracts which limit that ability "are a violation of the law."