Federal employees' health insurance companies cannot offer doctors and hospitals financial incentives to prevent them from discussing medically necessary but expensive procedures with patients, under a new rule the Office of Personnel Management announced Monday.
The new regulation, which covers the 350 health insurance companies that offer coverage to federal employees and retirees, prevents companies from including so-called "gag clauses" in contracts with doctors, hospitals and other health care providers. The clauses are sometimes used by insurance companies to control medical costs. The insurance companies offer health care providers bonuses, profit-sharing and other incentives to steer patients toward less expensive treatments. Critics--including President Clinton--say the clauses can prevent patients from getting the health care they need.
"When the bottom line becomes more important than patients' lives, when families have nowhere to turn when their loved ones are harmed by health care plans' bad decisions, when specialist care is denied and emergency care is not covered even when they are plainly needed and recommended by physicians, we must act," President Clinton said Monday during a speech in Louisville, Ky.
OPM created the new rule in response to an executive order President Clinton issued in February, instructing federal agencies to implement his Patients Bill of Rights in all federal health care programs.
In the regulation, OPM says that health plan sponsoring organizations with religious affiliations are not required to discuss procedures that are against their beliefs.
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