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Support for Physician Deception of Insurance Companies among a Sample of Philadelphia Residents

G Caleb Alexander, MD; Rachel M. Werner, MD; Angela Fagerlin, PhD; and Peter A. Ubel, MD
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From the University of Pennsylvania, Philadelphia, Pennsylvania; and Veterans Affairs Ann Arbor Healthcare System and the University of Michigan, Ann Arbor, Michigan.

Acknowledgments: The authors thank Kristen Lindeen and Tara Mohr for their research assistance and John Lantos, Ashwini Sehgal, and Matthew Wynia for comments on previous drafts.

Grant Support: Dr. Ubel is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar, recipient of a Career Development Award in Health Services Research from the Department of Veterans Affairs, and recipient of a Presidential Early Career Award for Scientists and Engineers (PECASE).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: G. Caleb Alexander, MD, Robert Wood Johnson Clinical Scholars Program, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637; e-mail, calexand@medicine.bsd.uchicago.edu.

Current Author Addresses: Dr. Alexander: Robert Wood Johnson Clinical Scholars Program, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.

Dr. Werner: Division of General Internal Medicine, University of Pennsylvania, Blockley Hall, 12th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021.

Drs. Fagerlin and Ubel: Program for Improving Health Care Divisions, Ann Arbor Veterans Affairs Medical Center and University of Michigan, 300 North Ingalls Street, Room 7C27, Ann Arbor, MI 48109-0429.

Author Contributions: Conception and design: G.C. Alexander, R.M. Werner, P.A. Ubel.

Analysis and interpretation of the data: G.C. Alexander, R.M. Werner, A. Fagerlin.

Drafting of the article: G.C. Alexander, R.M. Werner, PA. Ubel.

Critical revision of the article for important intellectual content: G.C. Alexander, R.M. Werner, A. Fagerlin, P.A. Ubel.

Final approval of the article: G.C. Alexander, R.M. Werner, A. Fagerlin, P.A. Ubel.

Provision of study materials or patients: P.A. Ubel.

Statistical expertise: P.A. Ubel.

Obtaining of funding: P.A. Ubel.

Administrative, technical, or logistic support: P.A. Ubel.

Collection and assembly of data: P.A. Ubel.

Ann Intern Med. 2003;138(6):472-475. doi:10.7326/0003-4819-138-6-200303180-00011
Text Size: A A A

Background: Some physicians seem to be willing to sanction deception of insurance companies. Little is known about public attitudes regarding this practice.

Objective: To assess public attitudes regarding physician deception of insurance companies.

Design: Cross-sectional survey using clinical vignettes.

Setting: Philadelphia County Courthouse, Philadelphia, Pennsylvania.

Participants: Convenience sample of 700 prospective jurors.

Measurements: Participants were asked whether, in response to restriction of health care, a physician should 1) accept restriction, 2) appeal restriction, or 3) misrepresent a patient's condition to obtain the desired service. The proportion of respondents reporting that the physician should misrepresent a patient's condition was determined.

Results: 26% of respondents sanctioned deception, 70% supported appealing, and 4% supported accepting the insurance company decision. Among the 27% of respondents believing physicians have inadequate time to appeal coverage decisions, 50% sanctioned deception.

Conclusions: Sanctioning of deception was substantial in this sample of prospective jurors. Preferences regarding insurance company deception are related to perceptions of physician workload and may further pressure physicians struggling to balance advocacy with honesty.





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Summary for Patients

Opinions about Doctors Deceiving Insurance Companies To Obtain Health Services for Their Patients

The summary below is from the full report titled “Support for Physician Deception of Insurance Companies among a Sample of Philadelphia Residents.” It is in the 18 March 2003 issue of Annals of Internal Medicine (volume 138, pages 472-475). The authors are GC Alexander, RM Werner, A Fagerlin, and PA Ubel.


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