Support for Physician Deception of Insurance Companies among a Sample of Philadelphia Residents

18 March 2003 | Volume 138 Issue 6 | Pages 472-475

Background: Some physicians seem to be willing to sanction deception of insurance companies. Little is known about public attitudes regarding this practice.

Objective: To assess public attitudes regarding physician deception of insurance companies.

Design: Cross-sectional survey using clinical vignettes.

Setting: Philadelphia County Courthouse, Philadelphia, Pennsylvania.

Participants: Convenience sample of 700 prospective jurors.

Measurements: Participants were asked whether, in response to restriction of health care, a physician should 1) accept restriction, 2) appeal restriction, or 3) misrepresent a patient's condition to obtain the desired service. The proportion of respondents reporting that the physician should misrepresent a patient's condition was determined.

Results: 26% of respondents sanctioned deception, 70% supported appealing, and 4% supported accepting the insurance company decision. Among the 27% of respondents believing physicians have inadequate time to appeal coverage decisions, 50% sanctioned deception.

Conclusions: Sanctioning of deception was substantial in this sample of prospective jurors. Preferences regarding insurance company deception are related to perceptions of physician workload and may further pressure physicians struggling to balance advocacy with honesty.

Editors' Notes Context Physicians sometimes must deceive insurance companies to get the insurers to cover certain needed health services for their patients. The public's attitude toward this form of deception is unknown. Contribution In this survey of 700 people waiting for jury duty in a Philadelphia courthouse, more than one quarter of people condoned physicians who deceive insurance companies for their patients' benefit. Among people who thought that physicians are overworked, 50% sanctioned deception. Implications Support for physician deception of insurance companies in order to get their patients coverage for health care services may be substantial. –The Editors

 

Author and Article Information

From the University of Pennsylvania, Philadelphia, Pennsylvania; and Veterans Affairs Ann Arbor Healthcare System and the University of Michigan, Ann Arbor, Michigan.

Acknowledgments: The authors thank Kristen Lindeen and Tara Mohr for their research assistance and John Lantos, Ashwini Sehgal, and Matthew Wynia for comments on previous drafts.

Grant Support: Dr. Ubel is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar, recipient of a Career Development Award in Health Services Research from the Department of Veterans Affairs, and recipient of a Presidential Early Career Award for Scientists and Engineers (PECASE).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: G. Caleb Alexander, MD, Robert Wood Johnson Clinical Scholars Program, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637; e-mail, calexand{at}medicine.bsd.uchicago.edu.

Current Author Addresses: Dr. Alexander: Robert Wood Johnson Clinical Scholars Program, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.

Dr. Werner: Division of General Internal Medicine, University of Pennsylvania, Blockley Hall, 12th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021.

Drs. Fagerlin and Ubel: Program for Improving Health Care Divisions, Ann Arbor Veterans Affairs Medical Center and University of Michigan, 300 North Ingalls Street, Room 7C27, Ann Arbor, MI 48109-0429.

Author Contributions: Conception and design: G.C. Alexander, R.M. Werner, P.A. Ubel.

Analysis and interpretation of the data: G.C. Alexander, R.M. Werner, A. Fagerlin.

Drafting of the article: G.C. Alexander, R.M. Werner, PA. Ubel.

Critical revision of the article for important intellectual content: G.C. Alexander, R.M. Werner, A. Fagerlin, P.A. Ubel.

Final approval of the article: G.C. Alexander, R.M. Werner, A. Fagerlin, P.A. Ubel.

Provision of study materials or patients: P.A. Ubel.

Statistical expertise: P.A. Ubel.

Obtaining of funding: P.A. Ubel.

Administrative, technical, or logistic support: P.A. Ubel.

Collection and assembly of data: P.A. Ubel.