Chiropractic Economics Blog

I am not a big fan of health-insurance companies. To me, they are like death and taxes: necessary but not nice.

Because I am not a big fan, I was pleasantly surprised by an April 3 newspaper article I read in the Indianapolis Star about WellPoint, the nation’s largest commercial health insurer in terms of membership. The article said that WellPoint would this year begin halting reimbursement payments to hospitals and doctors for 11 medical errors considered preventable.

Some of these errors include surgery on the wrong body part, a wrong surgery performed on a patient, surgery on the wrong patient, bed sores, sponges left in the body after surgery, urinary tract infections associated with catheter use, injuries due to falls, and blood incompatibility.

In 2007 the Centers for Medicare and Medicaid Services (CMS) authorized the nonpayment for six medical mistakes. (On April 14, the agency announced it would be seeking to withhold payment for nine additional preventable mistakes.) WellPoint, which provides healthcare benefits to about 35 million Americans, is following the lead of CMS. The newspaper said other insurers may also stop paying for certain medical errors.

Skeptic that I am (having been “burnt” many times by insurance companies), I immediately assumed that if WellPoint withheld payment for services (even though those services resulted in pain and suffering), the patient would be stuck with the bill.

Not so! Again following CMS’s lead, WellPoint said it would make sure its members are not billed for any of the errors it refuses to pay. Not only that, but according to the newspaper, officials at WellPoint, said any savings WellPoint gets from stopping payments for mistakes would result in reduced premiums for patients.

Bravo!

I am not a fan of insurance companies, but I am a fan of accountability. Doctors and nurses are not infallible; they make mistakes. But there is no excuse for mistakes that can be prevented. And there is no reason to reward healthcare providers for mistakes that could have been avoided.

Now if we could only get WellPoint and all other insurers to pay just claims on time, insurance companies might gain my respect.

Until next time,