US States Overturning HMO Gag Clauses

So far this year, 16 US states have adopted laws nullifying gag clauses imposed by managed care organizations on their doctors. Doctors' complaints include being told not to discuss either expensive treatment options not covered by their plans or financial incentives given them to withhold care. While open communication between doctor and patient on medical issues is something most health maintenance organizations say they favor, they also feel confidential business information and details of doctors' contracts should be private.

Adopting the laws are Colorado, Indiana, California, Delaware, Georgia, Maine, Maryland, Massachusetts, New Hampshire, New York, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia and Washington. The Oklahoma Board of Health is to enforce the same policy through licensing of HMOs, and the New Jersey Health Department proposes similar rules, reports the New York Times.

Varying Provisions The state laws vary, but all protect the rights of doctors and patients to talk about all treatment options. Some guarantee that doctors may not be punished if they serve as advocates for their patients, while others stipulate that doctors may tell patients about their financial arrangements with HMOs, including contracts that reward doctors for controlling health costs and limiting the use of medical specialists. The New York law provides a wide range of consumer protections, including requiring health plans to disclose in general terms how they pay doctors. California malpractice insurance companies joined with doctors to support that state's legislation because they felt doctors who withheld information, even when required to do so by an HMO which was their employer, increased their risk of being sued.