Tuesday, May 26, 2009

What Is An Hmo Gag Clause

HMOs used to add gag clauses to physician contracts to prevent discussion of uncovered treatment options with patients.


Before backlash forced them to change their contract wording, health maintenance organizations (HMOs) used gag clauses to prevent physicians from discussing diagnoses and treatment options with patients if the treatment was not covered in the physician contract.


Backlash From Physicians


Physicians fought hard against the HMO gag clause, saying it could destroy the trust between them and their patients. They also said the clause could significantly reduce the chances of recovery for a seriously ill patient requiring innovative treatment and full information about his illness.


Law Barring Gag Clauses


In December 1996, President Bill Clinton's administration prohibited the use of the gag clause by HMOs and other health plans that treat Medicaid patients.


Position of Associations


In a 1997 article, the "Wall Street Journal" reported that the American Medical Association had complained about doctors facing disciplinary actions from HMOs for discussing uncovered options. The American Association of Health Plans, which represents the HMO industry, responded by issuing statements against the use of gag clauses.


Gag Clauses Today


HMOs say they no longer use gag clauses. However, contract wording still warns physicians against making disparaging comments against HMOs.

Tags: contract wording, HMOs used, HMOs used clauses, options with, options with patients