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October 27, 2005

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Alcohol-related insurance denials in trauma centers are common, according to new study

Backed by 50-year-old law, threat of denial discourages ER & trauma center screening and counseling

DALLAS, TX –   A study published in a leading surgical journal sheds new light on trauma surgeons’ experiences with alcohol-related insurance denials, the denials’ effect on patient care, and the surgeons’ knowledge of laws nationwide that discourage screening and drug counseling in the ER and trauma center.   Alcohol is the leading cause of injuries seen in trauma centers.

The survey is the first to document how widespread these denials are and how little is known about state laws, in effect nationwide, that allow insurers to deny payment if a patient’s chart notes that he or she consumed even a minute amount of alcohol.  Results of this survey and a companion survey of state legislators are reported in the September 2005 Journal of Trauma, published October 27.

            “This survey shows that the Uniform Accident and Sickness Policy Provision law is widely used to deny coverage across the nation,” says Larry M. Gentilello, M.D., the study’s lead author and Chairman, Division of Burns, Trauma, and Critical Care, University of Texas Southwestern Medical School, Dallas.  “Although this law is terribly out of date, it continues to discourage surgeons from doing what they believe is best for their patients.”

The Uniform Accident and Sickness Policy Provision law (UPPL) was promulgated by the insurance industry as a model law and adopted by most state legislatures in 1947.  Still in effect in 35 states and the District of Columbia, UPPL allows insurance companies to deny payment for injuries that occur in patients who are under the influence of alcohol or illegal drugs. Eight states have recently repealed the law.

Of the 98 trauma surgeons responding to the survey, 13% believed they practiced in a UPPL state, but 70% actually did. Despite lack of knowledge of their state’s UPPL status, 24% reported an alcohol or drug-related insurance denial in the previous six months.  This appeared to affect screening practices: more than 51% did not routinely measure blood alcohol concentration (BAC), even though over 91% believed BAC testing is important.  Eighty-two percent indicated that if there were no insurance barriers, they would be willing to establish a brief alcohol intervention program in their center.

  “These interventions have been proven effective, yet little used,” says Dr. Gentilello. “We now know, however, that most trauma centers would consider establishing intervention programs if the insurance barriers were eliminated.”

In earlier research, Dr. Gentilello and colleagues showed that alcohol screening and intervention in trauma centers had dramatic effects.  More than 3,500 injured patients were screened for an alcohol problem, and 46 percent screened positive. Positive patients were randomly selected to have one 30-minute session with a specially trained alcohol counselor or no counseling. For the group that received counseling, ER visits or hospital admissions for repeat injuries dropped about 50 percent over the next three years.  Another recent study by Dr. Gentilello’s team found that offering brief substance-abuse counseling in emergency rooms and trauma centers to patients who were injured while under the influence of alcohol could save U.S. hospitals almost $2 billion a year.

 In the current study, the legislators’ survey responses were surprisingly similar to the surgeons’—indicating they were well aware of the impact of substance use on trauma centers. Eighty-nine percent of the 56 respondents agreed that alcohol problems are treatable, and 80% believed it is a good idea to offer counseling in trauma centers. As with surgeons, the majority (53%) were not sure if the UPPL existed in their state, but they favored prohibiting alcohol-related exclusions by a two to one ratio, with strong bipartisan support.

Dr. Gentilello adds, “Excessive alcohol use is the leading cause of injury that we see in trauma centers and ERs across the nation.  And there is broad support among both physicians and legislators for eliminating a significant barrier to diagnosis and treatment.”

Researchers from Harvard Medical School, University of California, San Diego and the Insurance Legislators Foundation also contributed to the current study.  The study was supported by The Robert Wood Johnson Foundation, which in 2002 honored Dr. Gentilello with its Innovators Combating Substance Abuse Award (www.innovatorsawards.org).  

Link to published paper in the Journal of Trauma.

Innovators Combating Substance Abuse is a national program of The Robert Wood Johnson Foundation that recognizes and rewards those who have made substantial, innovative contributions of national significance in the field of substance abuse. Each award includes a grant of $300,000, which is used to conduct a project over a period of up to three years that advances the field.  The program addresses problems related to alcohol, tobacco and illicit drugs, through education, advocacy, treatment and policy research and reform at the national, state and local levels.  The Innovators program is run by a national program office at The Johns Hopkins University School of Medicine.  For more information on Innovators Combating Substance Abuse, please visit www.innovatorsawards.org.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

Copyright 2004 The Johns Hopkins University. Baltimore, Maryland.
All rights reserved. Last Updated January 15, 2010
 

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