Wiki Is this unethical or illegal?

[jdangler]

I have a provider who is asking me to help their potential client in choosing their health plan. I cant find the verbiage for why this cant happen but I am assuming this would be a kickback issue? Is this illegal or unethical?

 

[Pam Warren]

This is a bit on the edge.....a provider can help a patient choose an insurance plan that most appropriately meets the patient's needs (for example a Medicare Advantage plan vs. a straight Medicare Plan), but providers should be very careful to not direct a patient to choose an insurance company solely because the insurance company pays them better. The best tactic with regards to this is to provide the patient with resources to assist them in making their coverage choices... either a patient advocate at the local hospital or local senior center. I'm going to assume positive intent here, but these kinds of financial decisions should be made with the support of someone who can advise solely on the patient's benefit and not with any potential monetary impact on the provider.

 

[jdangler]

This is a bit on the edge.....a provider can help a patient choose an insurance plan that most appropriately meets the patient's needs (for example a Medicare Advantage plan vs. a straight Medicare Plan), but providers should be very careful to not direct a patient to choose an insurance company solely because the insurance company pays them better. The best tactic with regards to this is to provide the patient with resources to assist them in making their coverage choices... either a patient advocate at the local hospital or local senior center. I'm going to assume positive intent here, but these kinds of financial decisions should be made with the support of someone who can advise solely on the patient's benefit and not with any potential monetary impact on the provider.

Thank you, Pam! The thing that worries me the most, is the patient has Medicaid right now, and no one is accepting this plan. So I was asked to help her with choose a health plan. I did send her the payers information with the phone number. I have always been told to never help a patient choose or suggest the health plans for patients.