Ethics and commercial insurance

Abstract

You have just seen a 59-year-old diabetic woman with a several year history of debilitating claudication that has recently progressed to rest pain. She has just changed employers, and her new health insurance plan specifically excludes pre-existing conditions. She explains that she did not specify her peripheral vascular disease symptoms on her enrollment form because she considered them muscle spasms. To obtain treatment approval from the insurer, your billing clerk needs to know whether or not the condition pre-existed. Your response?A. Get the approval by whatever means necessary. It is ethical to skirt insurer's restrictions to help your patient. B. Call the insurer and formally appeal on the patient's behalf. C. Tell the patient to call an attorney. D. Petition your congressional representatives to enact laws prohibiting pre-existing condition clauses in private plans. E. Tell your patient to quit her job and apply for Medicaid.