Denial of Care Due to Alcohol Use

Or, the Insurance Company won’t be picking up the tab… car-crash-and-bill.jpg

It’s probably not a surprise that a disproportionate number of patients involved in Traumas are under the influence of alcohol, and/or drugs. However, once they’re injured and in the Trauma system, every effort is made for them, just like you’d want if it were you who were injured.

In an interesting article on MedScape, Dr. Larry M. Gentilello of the UT Southwestern Medical School (Parkland Hospital) in Dallas was interviewed about alcohol screening and intervention with trauma victims, and barriers to that screening. Interestingly but not surprisingly, it’s money.

Turns out there’s a law called the UPPL, and:

The Uniform Accident and Sickness Policy Provision Law (UPPL), first adopted by most U.S. state legislatures in 1947, allows insurers to deny payment of medical bills if records document any amount of alcohol consumption, even if the condition being treated is not causally related to alcohol use.

Yeah, read that again. I didn’t know either, and it’s the law in 42 states.

Unsurprisingly, guess what? The insurance companies do know and they aren’t shy about denying claims on these grounds. This cheats the hospital and the treating doctor, as hospital care isn’t free and trauma care is particularly expensive.

The denial of care they’re focusing on in the article is access to alcohol intervention and treatment programs for alcoholism, and they cite a study done at Harbor View in Seattle that had good short and long-term results. But, docs aren’t going to go fishing for information that allow insurance companies a fully legal but morally fishy loophole to wriggle out of their medical bill.

The American Public Health Association has an unambiguous statement against the UPPL from 2004:

Therefore APHA:
1. Calls upon state legislatures and state insurance commissioners to adopt the 2002 National Association of Insurance Commissioners UPPL amendment that prohibits insurers from denying reimbursement on the basis of patient intoxicant use; and
2. Calls upon state legislatures that did not adopt the original 1947 UPPL Model to pass a statute that specifically prohibits insurers from engaging in this practice.

Dr. Gentiello has been working to get this law repealed for a while. Here’s a speech of his from 2002 on the subject.

Read the article (it’s about 30 short paragraphs), and it’s good information. Now I’m not happy about getting all those ‘routine’ BAL’s.