Patient Safety and Your Insurance Policy

Patient safety is not only the concern of hospitals, but also of the insurance companies that pay so much of the bill and are often responsible to consumers for the healthcare provided under their plans. In 1999 an Institute of Medicine report found that an average of 98,000 Americans die each year because of medical mistakes, a sobering statistic that has led to the creation of the Leapfrog Group, a consumer advocacy group that rewards the healthcare industry for advancements in patient safety. However, despite the attention paid to this issue, by 2004 this number had reached 195,000. This means that medical mistakes are now the leading cause of death in America.

Medical errors can take many different forms. They may be billing mistakes, errors in type or quantity of medication, mistakes in treatment, or even the wrong kinds of surgery. Time spent convalescing also opens the door for a number of patient care and hygienic errors that could expose patients to dangerous bacteria. For most of these errors there are both methods of prevention, and as well as ways consumers can protect themselves and their finances.

Remember that insurance agencies are not medical experts, nor do they keep track of your condition and reactions to treatment in the same way doctors do. If an error has occurred, the patient or their family is often the first person to notice. In some cases, as narrated by Dr. Harper, insurance companies can even jeopardize patient safety with their stricter policies. Eventually, the health of the patient will come down to the decisions they make, and when their safety or that of a loved one is at stake, it is vital that they understand their insurance company’s policy regarding medical safety and what they can do when a mistake is made.



Health Insurance Perspectives

Because medical errors can result in a loss of business, extra work, and often extensive lawsuits, insurance companies are very anxious to avoid them. Insurers have a vested interest in ensuring their customers recover properly. If they cannot trust health providers on their plans, they are not selling a worthwhile product. So, it comes as no surprise that insurance companies are an ideal source of information on patient safety, medical mistakes, and the notification processesq. Check with your own insurance company to see what they say on their website. Here are a few common examples:

Aetna: The Aetna website offers links to medication information, since “More people die of [medical] mistakes each year from highway accidents, breast cancer, or AIDS.” It also includes a list of links for patient safety.

ProHEALTH: This ProHEALTH document contains a list of patient rights you can peruse, such as the right to “Receive all the information that you need to give informed consent for any proposed procedure or treatment. This information shall include the possible risks and benefits of the procedure or treatment.”

TRICARE: TRICARE’s webpage on patient safety offers specific advice, like, “Keep a record of all your medications, vitamins and herbal supplements,” and “If you need surgery, make sure you and the surgeon agree on exactly what is going to be done, including the surgeon marking the surgical site.”



Taking Action

If you believe a medical error has endangered your safety as a patient, do not hesitate to address those concerns with your health insurance company. If you have kept good records of your treatments and bills, you will be in a strong position to ask questions and request further information. Every health insurance company has a compliance officer or other agent that ensures proper conduct of healthcare providers. Contact this agent at your local branch and explain the problem – their information should be easy to obtain with a quick call or scan of the company website. Send the agent a report including all the data you have after your conversation. The compliance agent can provide additional information, start an investigation, and halt payment to the healthcare provider until the issue is resolved.

Next, you can also choose to contact the appropriate state agency in your area. For example, New York has an Office of Professional Medical Conduct department you can contact to explain the problem or file a complaint. If the medical error was serious, this can lead to investigations, government suits and will, most importantly, protect other patients. A lawsuit on your own part is also an option, although malpractice insurance has become so common among medical professional that a personal lawsuit may not help solve problems for future patients.



Want to Learn More? Try These Sites: Be Safe – Check Your Hospital’s Patient Safety Rating Before an Admission

HHS: Health Information Privacy

AHIP: Patient Safety Reports

U.S. Department of Veterans Affairs: Patient Safety