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Posted
Posted

 Hi Joy and all:

 

 This is a troublesome topic, because it is easy to get into this cross-cultural

business. Western Medical ethics are not Chinese Medical ethics. The medical

ethics of a court / imperial doctor were not the ethics of the mendicant taoist

healer.

 

 The ethics of our uptight modern western profession are severely tainted by a

historical influx of scientists from the engineering, physical and chemical

sciences who deeply believed in the separation of the person from the body and

further had an ansolutely abysmal understanding of the human heart and human

warmth. These are the same people who believed animals (including our closest

relatives the apes) to be mere machines with no ability to feel pain or emotion

and who also did not believe that human beings possessed soul. This brought a

deep level of depersonalisation to the modern western field. We see it today in

standard neurology where the direction of causation is bottom up - i.e. the

substrate generates consciousness - consciousness is nothing more than brain

chemicals interacting. These aren't actually " medical " ethics, is what I am

saying.

 

 The chinese, in their deep wisdom, understood that ethics were not about a set

of fixed rules. Witness the famous story regarding the celibate teacher who

broke the rule of not touching women when he picked up a young lady and carried

her across the stream. I hope he was disciplined by his association (turned in,

of course, by his shocked and outraged disciple). This is a great story about

projection and transference and how dangerous fixation and obsession are.

 

 If we talk about ethics in terms of legalism, however, we can find fruitful

territory in terms of the defense and protection of our profession, as well as

about insurance and such.

 

 By the way, it actually slipped my mind, interestingly: I am the primary

caregiver for my father. Turn me in.

 

 I wonder how old family lineage doctors managed the treatment of their

families, especially if they were the only doctor within a day or two's walk? I

can't imagine the classical martial arts scholar doctor not treating his son or

daughter when they were sick as children because " they were his family " . In

fact, I would imagine that it is the parents who would be most deeply familiar

with the subtleties of their children's dynamics and would therefore be the most

prepared to take care of them to best effect.

 

 I also think modern " medical ethics " are an outgrowth of the logistics of a

system where a collision is occurring between insufficient numbers of medical

therapists, the constant and looming threat of litigation, a growing number of

fractured and dysfunctional families and a huge emphasis on the supremacy of the

individual. I mean, kids can send their parents to jail and divorce them and all

manner of unethical stuff. All these issues regarding lack of trust. But we have

psychologists these days to make up for lack of community strength. I'm not sure

if it is working.

 

 Again, I don't see the link between " their " medical ethics and " our " medical

ethics. Interestingly, in latin culture the family takes care of the family. And

if there is a doctor who is not in the family who is taking care of the family,

then that doctor becomes part of the family (how else do you ensure

accountability? interesting).

 

 In my opinion, modern medical ethics are deeply confused and insidiously

damaging to human relationships.

 

 Thoughts?

 

 Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

 

 

 

 

________________________________

Joy Keller <JKellerLAc

Chinese Medicine

Saturday, 20 June, 2009 2:23:30

Re: Spouse/insurance

 

 

 

 

 

Medical professional ethics dictate that we should not treat family members

unless it is in an emergency or short-term situation where no other care

provider is available. There is a great online course about our medical

professional ethics at Blue Poppy that details all the reasons why (too long

for an email here) as well as all the other professional ethics to which we

are bound.

 

Btw, this isn't just about LAc's. This is any doctor in any field not

treating family members.

 

We (meaning all licensed health care providers) are bound by both legal and

professional ethics. Violations in either arena are grounds for disciplinary

action that could result in the loss of licensure.

 

I'm not saying that people don't treat their own family members, just that

professional ethics state that we should not (or is it " must " not?).

 

J

 

On Fri, Jun 19, 2009 at 8:33 PM, heylaurag <heylaurag (AT) hotmail (DOT) com> wrote:

 

> Hi, I was wondering if anyone knows if its ok to bill insurance companies

> for treating family members/spouses? I asked a customer service agent at

> AETNA and she said there was no rule against it from AETNA but mentioned

> that there may be an ethical standard in the profession. Anyone know? I

> treat my husband all the time and so it would be nice to be paid for it.

>

> Thanks!

>

> Laura

>

> ____________ _________ _________ _________ ___

Joy Keller, LAc, Dipl.OM

Ramona Acupuncture & Integrative Medicine Clinic

Phone: (760) 654-1040 Fax: (760) 654-4019

www.RamonaAcupunctu re.com

 

 

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Posted
Posted

Hugo,

There appears to be some confusion of historical with current ethical

understanding, which by the way is established by the various professions.

From my understanding the issue here is related to insurance reimbursements, and

ethics would suggest that while treatment of our family can be done, it cannot

be billed to a third party payor.

The scenario is important here for our complete understanding. Our profession

has had a lot of trouble doing the correct things in the past, largely due to

our anti-establishment mentality. We want to be artists and not just

technicians.

 

Michael W. Bowser, DC, LAc

 

Chinese Medicine

subincor

Mon, 22 Jun 2009 16:24:41 +0000

Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi Joy and all:

 

 

 

This is a troublesome topic, because it is easy to get into this cross-cultural

business. Western Medical ethics are not Chinese Medical ethics. The medical

ethics of a court / imperial doctor were not the ethics of the mendicant taoist

healer.

 

 

 

The ethics of our uptight modern western profession are severely tainted by a

historical influx of scientists from the engineering, physical and chemical

sciences who deeply believed in the separation of the person from the body and

further had an ansolutely abysmal understanding of the human heart and human

warmth. These are the same people who believed animals (including our closest

relatives the apes) to be mere machines with no ability to feel pain or emotion

and who also did not believe that human beings possessed soul. This brought a

deep level of depersonalisation to the modern western field. We see it today in

standard neurology where the direction of causation is bottom up - i.e. the

substrate generates consciousness - consciousness is nothing more than brain

chemicals interacting. These aren't actually " medical " ethics, is what I am

saying.

 

 

 

The chinese, in their deep wisdom, understood that ethics were not about a set

of fixed rules. Witness the famous story regarding the celibate teacher who

broke the rule of not touching women when he picked up a young lady and carried

her across the stream. I hope he was disciplined by his association (turned in,

of course, by his shocked and outraged disciple). This is a great story about

projection and transference and how dangerous fixation and obsession are.

 

 

 

If we talk about ethics in terms of legalism, however, we can find fruitful

territory in terms of the defense and protection of our profession, as well as

about insurance and such.

 

 

 

By the way, it actually slipped my mind, interestingly: I am the primary

caregiver for my father. Turn me in.

 

 

 

I wonder how old family lineage doctors managed the treatment of their

families, especially if they were the only doctor within a day or two's walk? I

can't imagine the classical martial arts scholar doctor not treating his son or

daughter when they were sick as children because " they were his family " . In

fact, I would imagine that it is the parents who would be most deeply familiar

with the subtleties of their children's dynamics and would therefore be the most

prepared to take care of them to best effect.

 

 

 

I also think modern " medical ethics " are an outgrowth of the logistics of a

system where a collision is occurring between insufficient numbers of medical

therapists, the constant and looming threat of litigation, a growing number of

fractured and dysfunctional families and a huge emphasis on the supremacy of the

individual. I mean, kids can send their parents to jail and divorce them and all

manner of unethical stuff. All these issues regarding lack of trust. But we have

psychologists these days to make up for lack of community strength. I'm not sure

if it is working.

 

 

 

Again, I don't see the link between " their " medical ethics and " our " medical

ethics. Interestingly, in latin culture the family takes care of the family. And

if there is a doctor who is not in the family who is taking care of the family,

then that doctor becomes part of the family (how else do you ensure

accountability? interesting).

 

 

 

In my opinion, modern medical ethics are deeply confused and insidiously

damaging to human relationships.

 

 

 

Thoughts?

 

 

 

Hugo

 

________________________________

 

Hugo Ramiro

 

http://middlemedicine.wordpress.com

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

Joy Keller <JKellerLAc

 

Chinese Medicine

 

Saturday, 20 June, 2009 2:23:30

 

Re: Spouse/insurance

 

 

 

Medical professional ethics dictate that we should not treat family members

 

unless it is in an emergency or short-term situation where no other care

 

provider is available. There is a great online course about our medical

 

professional ethics at Blue Poppy that details all the reasons why (too long

 

for an email here) as well as all the other professional ethics to which we

 

are bound.

 

 

 

Btw, this isn't just about LAc's. This is any doctor in any field not

 

treating family members.

 

 

 

We (meaning all licensed health care providers) are bound by both legal and

 

professional ethics. Violations in either arena are grounds for disciplinary

 

action that could result in the loss of licensure.

 

 

 

I'm not saying that people don't treat their own family members, just that

 

professional ethics state that we should not (or is it " must " not?).

 

 

 

J

 

 

 

On Fri, Jun 19, 2009 at 8:33 PM, heylaurag <heylaurag (AT) hotmail (DOT) com> wrote:

 

 

 

> Hi, I was wondering if anyone knows if its ok to bill insurance companies

 

> for treating family members/spouses? I asked a customer service agent at

 

> AETNA and she said there was no rule against it from AETNA but mentioned

 

> that there may be an ethical standard in the profession. Anyone know? I

 

> treat my husband all the time and so it would be nice to be paid for it.

 

>

 

> Thanks!

 

>

 

> Laura

 

>

 

> ____________ _________ _________ _________ ___

 

Joy Keller, LAc, Dipl.OM

 

Ramona Acupuncture & Integrative Medicine Clinic

 

Phone: (760) 654-1040 Fax: (760) 654-4019

 

www.RamonaAcupunctu re.com

 

 

 

 

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Posted
Posted

 Hi Mike;

 

 I agree that there is a legalistic issue which I mentioned in my post, but the

bulk of my post was referencing the idea that our medical ethics are the same as

western medical ethics, which they are not.

 

  Thanks,

 Hugo

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

 

 

 

 

________________________________

mike Bowser <naturaldoc1

Chinese Traditional Medicine

Monday, 22 June, 2009 12:41:39

RE: Was: Spouse/insurance - Now: Medical Ethics

 

 

Hugo,

There appears to be some confusion of historical with current ethical

understanding, which by the way is established by the various professions. 

From my understanding the issue here is related to insurance reimbursements, and

ethics would suggest that while treatment of our family can be done, it cannot

be billed to a third party payor. 

The scenario is important here for our complete understanding.  Our profession

has had a lot of trouble doing the correct things in the past, largely due to

our anti-establishment mentality.  We want to be artists and not just

technicians.   

 

Michael W. Bowser, DC, LAc

 

Chinese Medicine

subincor

Mon, 22 Jun 2009 16:24:41 +0000

Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

           

           

 

 

     

      Hi Joy and all:

 

 

 

This is a troublesome topic, because it is easy to get into this cross-cultural

business. Western Medical ethics are not Chinese Medical ethics. The medical

ethics of a court / imperial doctor were not the ethics of the mendicant taoist

healer.

 

 

 

The ethics of our uptight modern western profession are severely tainted by a

historical influx of scientists from the engineering, physical and chemical

sciences who deeply believed in the separation of the person from the body and

further had an ansolutely abysmal understanding of the human heart and human

warmth. These are the same people who believed animals (including our closest

relatives the apes) to be mere machines with no ability to feel pain or emotion

and who also did not believe that human beings possessed soul. This brought a

deep level of depersonalisation to the modern western field. We see it today in

standard neurology where the direction of causation is bottom up - i.e. the

substrate generates consciousness - consciousness is nothing more than brain

chemicals interacting. These aren't actually " medical " ethics, is what I am

saying.

 

 

 

The chinese, in their deep wisdom, understood that ethics were not about a set

of fixed rules. Witness the famous story regarding the celibate teacher who

broke the rule of not touching women when he picked up a young lady and carried

her across the stream. I hope he was disciplined by his association (turned in,

of course, by his shocked and outraged disciple). This is a great story about

projection and transference and how dangerous fixation and obsession are.

 

 

 

If we talk about ethics in terms of legalism, however, we can find fruitful

territory in terms of the defense and protection of our profession, as well as

about insurance and such.

 

 

 

By the way, it actually slipped my mind, interestingly: I am the primary

caregiver for my father. Turn me in.

 

 

 

I wonder how old family lineage doctors managed the treatment of their families,

especially if they were the only doctor within a day or two's walk? I can't

imagine the classical martial arts scholar doctor not treating his son or

daughter when they were sick as children because " they were his family " . In

fact, I would imagine that it is the parents who would be most deeply familiar

with the subtleties of their children's dynamics and would therefore be the most

prepared to take care of them to best effect.

 

 

 

I also think modern " medical ethics " are an outgrowth of the logistics of a

system where a collision is occurring between insufficient numbers of medical

therapists, the constant and looming threat of litigation, a growing number of

fractured and dysfunctional families and a huge emphasis on the supremacy of the

individual. I mean, kids can send their parents to jail and divorce them and all

manner of unethical stuff. All these issues regarding lack of trust. But we have

psychologists these days to make up for lack of community strength. I'm not sure

if it is working.

 

 

 

Again, I don't see the link between " their " medical ethics and " our " medical

ethics. Interestingly, in latin culture the family takes care of the family. And

if there is a doctor who is not in the family who is taking care of the family,

then that doctor becomes part of the family (how else do you ensure

accountability? interesting).

 

 

 

In my opinion, modern medical ethics are deeply confused and insidiously

damaging to human relationships.

 

 

 

Thoughts?

 

 

 

Hugo

 

________________________________

 

Hugo Ramiro

 

http://middlemedicine.wordpress.com

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

Joy Keller <JKellerLAc

 

Chinese Medicine

 

Saturday, 20 June, 2009 2:23:30

 

Re: Spouse/insurance

 

 

 

Medical professional ethics dictate that we should not treat family members

 

unless it is in an emergency or short-term situation where no other care

 

provider is available. There is a great online course about our medical

 

professional ethics at Blue Poppy that details all the reasons why (too long

 

for an email here) as well as all the other professional ethics to which we

 

are bound.

 

 

 

Btw, this isn't just about LAc's. This is any doctor in any field not

 

treating family members.

 

 

 

We (meaning all licensed health care providers) are bound by both legal and

 

professional ethics. Violations in either arena are grounds for disciplinary

 

action that could result in the loss of licensure.

 

 

 

I'm not saying that people don't treat their own family members, just that

 

professional ethics state that we should not (or is it " must " not?).

 

 

 

J

 

 

 

On Fri, Jun 19, 2009 at 8:33 PM, heylaurag <heylaurag (AT) hotmail (DOT) com> wrote:

 

 

 

> Hi, I was wondering if anyone knows if its ok to bill insurance companies

 

> for treating family members/spouses? I asked a customer service agent at

 

> AETNA and she said there was no rule against it from AETNA but mentioned

 

> that there may be an ethical standard in the profession. Anyone know? I

 

> treat my husband all the time and so it would be nice to be paid for it.

 

>

 

> Thanks!

 

>

 

> Laura

 

>

 

> ____________ _________ _________ _________ ___

 

Joy Keller, LAc, Dipl.OM

 

Ramona Acupuncture & Integrative Medicine Clinic

 

Phone: (760) 654-1040 Fax: (760) 654-4019

 

www.RamonaAcupunctu re.com

 

 

 

 

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Posted
Posted

I think we need to be free from extremes in this subject, AND acknowledge that

we don't live in a perfect world. I personally think that it's a good idea to

avoid dual relationships, and I think my partner would be best served by going

to a clinic where he is a client and has no other constraints or privileges. We

often note that treatments for my partner are squished in at the end of the day,

or they only happen when there is a break in the schedule. HOWEVER, in a perfect

world access to medical care would be affordable and uncomplicated, but it's

not, our insurance only covers a very few treatments, and then I usually do the

additional ones in our clinic. This does not feel unethical to me at all,

however, I would NEVER bill my husband's insurance, you can really get into

trouble big time that way.

 

Regards,

Angela Pfaffenberger, Ph.D.

 

angelapfa

 

www.InnerhealthSalem.com

 

Phone: 503 364 3022

-

Hugo Ramiro

Chinese Medicine

Monday, June 22, 2009 9:24 AM

Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

Hi Joy and all:

 

This is a troublesome topic, because it is easy to get into this

cross-cultural business. Western Medical ethics are not Chinese Medical ethics.

The medical ethics of a court / imperial doctor were not the ethics of the

mendicant taoist healer.

 

The ethics of our uptight modern western profession are severely tainted by a

historical influx of scientists from the engineering, physical and chemical

sciences who deeply believed in the separation of the person from the body and

further had an ansolutely abysmal understanding of the human heart and human

warmth. These are the same people who believed animals (including our closest

relatives the apes) to be mere machines with no ability to feel pain or emotion

and who also did not believe that human beings possessed soul. This brought a

deep level of depersonalisation to the modern western field. We see it today in

standard neurology where the direction of causation is bottom up - i.e. the

substrate generates consciousness - consciousness is nothing more than brain

chemicals interacting. These aren't actually " medical " ethics, is what I am

saying.

 

The chinese, in their deep wisdom, understood that ethics were not about a

set of fixed rules. Witness the famous story regarding the celibate teacher who

broke the rule of not touching women when he picked up a young lady and carried

her across the stream. I hope he was disciplined by his association (turned in,

of course, by his shocked and outraged disciple). This is a great story about

projection and transference and how dangerous fixation and obsession are.

 

If we talk about ethics in terms of legalism, however, we can find fruitful

territory in terms of the defense and protection of our profession, as well as

about insurance and such.

 

By the way, it actually slipped my mind, interestingly: I am the primary

caregiver for my father. Turn me in.

 

I wonder how old family lineage doctors managed the treatment of their

families, especially if they were the only doctor within a day or two's walk? I

can't imagine the classical martial arts scholar doctor not treating his son or

daughter when they were sick as children because " they were his family " . In

fact, I would imagine that it is the parents who would be most deeply familiar

with the subtleties of their children's dynamics and would therefore be the most

prepared to take care of them to best effect.

 

I also think modern " medical ethics " are an outgrowth of the logistics of a

system where a collision is occurring between insufficient numbers of medical

therapists, the constant and looming threat of litigation, a growing number of

fractured and dysfunctional families and a huge emphasis on the supremacy of the

individual. I mean, kids can send their parents to jail and divorce them and all

manner of unethical stuff. All these issues regarding lack of trust. But we have

psychologists these days to make up for lack of community strength. I'm not sure

if it is working.

 

Again, I don't see the link between " their " medical ethics and " our " medical

ethics. Interestingly, in latin culture the family takes care of the family. And

if there is a doctor who is not in the family who is taking care of the family,

then that doctor becomes part of the family (how else do you ensure

accountability? interesting).

 

In my opinion, modern medical ethics are deeply confused and insidiously

damaging to human relationships.

 

Thoughts?

 

Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

________________________________

Joy Keller <JKellerLAc

Chinese Medicine

Saturday, 20 June, 2009 2:23:30

Re: Spouse/insurance

 

Medical professional ethics dictate that we should not treat family members

unless it is in an emergency or short-term situation where no other care

provider is available. There is a great online course about our medical

professional ethics at Blue Poppy that details all the reasons why (too long

for an email here) as well as all the other professional ethics to which we

are bound.

 

Btw, this isn't just about LAc's. This is any doctor in any field not

treating family members.

 

We (meaning all licensed health care providers) are bound by both legal and

professional ethics. Violations in either arena are grounds for disciplinary

action that could result in the loss of licensure.

 

I'm not saying that people don't treat their own family members, just that

professional ethics state that we should not (or is it " must " not?).

 

J

 

On Fri, Jun 19, 2009 at 8:33 PM, heylaurag <heylaurag (AT) hotmail (DOT) com> wrote:

 

> Hi, I was wondering if anyone knows if its ok to bill insurance companies

> for treating family members/spouses? I asked a customer service agent at

> AETNA and she said there was no rule against it from AETNA but mentioned

> that there may be an ethical standard in the profession. Anyone know? I

> treat my husband all the time and so it would be nice to be paid for it.

>

> Thanks!

>

> Laura

>

> ____________ _________ _________ _________ ___

Joy Keller, LAc, Dipl.OM

Ramona Acupuncture & Integrative Medicine Clinic

Phone: (760) 654-1040 Fax: (760) 654-4019

www.RamonaAcupunctu re.com

 

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Posted
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Hugo,

Actually, they are. This is part of my point as well and what Joy was pointing

out as well.

As OM professionals, we often make excuses for questionable behaviors and simply

think that we are not medical doctors, therefore we do not need to follow these

rules, but we do.

I think that most state acupuncture statutes have clauses about ethics and

punishment for not following them or maybe that was just the two states that I

happen to have acupuncture licenses in.

I have heard gasping from many LAc's that do not appear to understand our legal

responsibilities. The AAC does a good job at their seminars of dispelling this

myth.

 

Michael W. Bowser, DC, LAc

 

Chinese Medicine

subincor

Mon, 22 Jun 2009 17:32:03 +0000

Re: Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi Mike;

 

 

 

I agree that there is a legalistic issue which I mentioned in my post, but the

bulk of my post was referencing the idea that our medical ethics are the same as

western medical ethics, which they are not.

 

 

 

Thanks,

 

Hugo

 

 

 

________________________________

 

Hugo Ramiro

 

http://middlemedicine.wordpress.com

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

mike Bowser <naturaldoc1

 

Chinese Traditional Medicine

 

Monday, 22 June, 2009 12:41:39

 

RE: Was: Spouse/insurance - Now: Medical Ethics

 

 

 

Hugo,

 

There appears to be some confusion of historical with current ethical

understanding, which by the way is established by the various professions.

 

From my understanding the issue here is related to insurance reimbursements, and

ethics would suggest that while treatment of our family can be done, it cannot

be billed to a third party payor.

 

The scenario is important here for our complete understanding. Our profession

has had a lot of trouble doing the correct things in the past, largely due to

our anti-establishment mentality. We want to be artists and not just

technicians.

 

 

 

Michael W. Bowser, DC, LAc

 

 

 

Chinese Medicine

 

subincor

 

Mon, 22 Jun 2009 16:24:41 +0000

 

Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi Joy and all:

 

 

 

This is a troublesome topic, because it is easy to get into this cross-cultural

business. Western Medical ethics are not Chinese Medical ethics. The medical

ethics of a court / imperial doctor were not the ethics of the mendicant taoist

healer.

 

 

 

The ethics of our uptight modern western profession are severely tainted by a

historical influx of scientists from the engineering, physical and chemical

sciences who deeply believed in the separation of the person from the body and

further had an ansolutely abysmal understanding of the human heart and human

warmth. These are the same people who believed animals (including our closest

relatives the apes) to be mere machines with no ability to feel pain or emotion

and who also did not believe that human beings possessed soul. This brought a

deep level of depersonalisation to the modern western field. We see it today in

standard neurology where the direction of causation is bottom up - i.e. the

substrate generates consciousness - consciousness is nothing more than brain

chemicals interacting. These aren't actually " medical " ethics, is what I am

saying.

 

 

 

The chinese, in their deep wisdom, understood that ethics were not about a set

of fixed rules. Witness the famous story regarding the celibate teacher who

broke the rule of not touching women when he picked up a young lady and carried

her across the stream. I hope he was disciplined by his association (turned in,

of course, by his shocked and outraged disciple). This is a great story about

projection and transference and how dangerous fixation and obsession are.

 

 

 

If we talk about ethics in terms of legalism, however, we can find fruitful

territory in terms of the defense and protection of our profession, as well as

about insurance and such.

 

 

 

By the way, it actually slipped my mind, interestingly: I am the primary

caregiver for my father. Turn me in.

 

 

 

I wonder how old family lineage doctors managed the treatment of their families,

especially if they were the only doctor within a day or two's walk? I can't

imagine the classical martial arts scholar doctor not treating his son or

daughter when they were sick as children because " they were his family " . In

fact, I would imagine that it is the parents who would be most deeply familiar

with the subtleties of their children's dynamics and would therefore be the most

prepared to take care of them to best effect.

 

 

 

I also think modern " medical ethics " are an outgrowth of the logistics of a

system where a collision is occurring between insufficient numbers of medical

therapists, the constant and looming threat of litigation, a growing number of

fractured and dysfunctional families and a huge emphasis on the supremacy of the

individual. I mean, kids can send their parents to jail and divorce them and all

manner of unethical stuff. All these issues regarding lack of trust. But we have

psychologists these days to make up for lack of community strength. I'm not sure

if it is working.

 

 

 

Again, I don't see the link between " their " medical ethics and " our " medical

ethics. Interestingly, in latin culture the family takes care of the family. And

if there is a doctor who is not in the family who is taking care of the family,

then that doctor becomes part of the family (how else do you ensure

accountability? interesting).

 

 

 

In my opinion, modern medical ethics are deeply confused and insidiously

damaging to human relationships.

 

 

 

Thoughts?

 

 

 

Hugo

 

 

 

________________________________

 

 

 

Hugo Ramiro

 

 

 

http://middlemedicine.wordpress.com

 

 

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

 

 

Joy Keller <JKellerLAc

 

 

 

Chinese Medicine

 

 

 

Saturday, 20 June, 2009 2:23:30

 

 

 

Re: Spouse/insurance

 

 

 

Medical professional ethics dictate that we should not treat family members

 

 

 

unless it is in an emergency or short-term situation where no other care

 

 

 

provider is available. There is a great online course about our medical

 

 

 

professional ethics at Blue Poppy that details all the reasons why (too long

 

 

 

for an email here) as well as all the other professional ethics to which we

 

 

 

are bound.

 

 

 

Btw, this isn't just about LAc's. This is any doctor in any field not

 

 

 

treating family members.

 

 

 

We (meaning all licensed health care providers) are bound by both legal and

 

 

 

professional ethics. Violations in either arena are grounds for disciplinary

 

 

 

action that could result in the loss of licensure.

 

 

 

I'm not saying that people don't treat their own family members, just that

 

 

 

professional ethics state that we should not (or is it " must " not?).

 

 

 

J

 

 

 

On Fri, Jun 19, 2009 at 8:33 PM, heylaurag <heylaurag (AT) hotmail (DOT) com> wrote:

 

 

 

> Hi, I was wondering if anyone knows if its ok to bill insurance companies

 

 

 

> for treating family members/spouses? I asked a customer service agent at

 

 

 

> AETNA and she said there was no rule against it from AETNA but mentioned

 

 

 

> that there may be an ethical standard in the profession. Anyone know? I

 

 

 

> treat my husband all the time and so it would be nice to be paid for it.

 

 

 

>

 

 

 

> Thanks!

 

 

 

>

 

 

 

> Laura

 

 

 

>

 

 

 

> ____________ _________ _________ _________ ___

 

 

 

Joy Keller, LAc, Dipl.OM

 

 

 

Ramona Acupuncture & Integrative Medicine Clinic

 

 

 

Phone: (760) 654-1040 Fax: (760) 654-4019

 

 

 

www.RamonaAcupunctu re.com

 

 

 

 

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Posted
Posted

 Hi Mike:

 

 Actually our ethics are different.

 

 We are legally bound to follow the laws in our nations and states.

 

 Please don't diminish or ignore the points which I have made in good faith.

 

 Chinese medical ethics are distinct from western medical ethics. Period.

 

 Hugo

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

 

 

 

 

________________________________

mike Bowser <naturaldoc1

Chinese Traditional Medicine

Monday, 22 June, 2009 18:53:11

RE: Was: Spouse/insurance - Now: Medical Ethics

 

 

Hugo,

Actually, they are.  This is part of my point as well and what Joy was pointing

out as well. 

As OM professionals, we often make excuses for questionable behaviors and simply

think that we are not medical doctors, therefore we do not need to follow these

rules, but we do. 

I think that most state acupuncture statutes have clauses about ethics and

punishment for not following them or maybe that was just the two states that I

happen to have acupuncture licenses in. 

I have heard gasping from many LAc's that do not appear to understand our legal

responsibilities.  The AAC does a good job at their seminars of dispelling this

myth. 

 

Michael W. Bowser, DC, LAc

 

Chinese Medicine

subincor

Mon, 22 Jun 2009 17:32:03 +0000

Re: Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

           

           

 

 

     

      Hi Mike;

 

 

 

I agree that there is a legalistic issue which I mentioned in my post, but the

bulk of my post was referencing the idea that our medical ethics are the same as

western medical ethics, which they are not.

 

 

 

  Thanks,

 

Hugo

 

 

 

________________________________

 

Hugo Ramiro

 

http://middlemedicine.wordpress.com

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

mike Bowser <naturaldoc1

 

Chinese Traditional Medicine

 

Monday, 22 June, 2009 12:41:39

 

RE: Was: Spouse/insurance - Now: Medical Ethics

 

 

 

Hugo,

 

There appears to be some confusion of historical with current ethical

understanding, which by the way is established by the various professions. 

 

From my understanding the issue here is related to insurance reimbursements, and

ethics would suggest that while treatment of our family can be done, it cannot

be billed to a third party payor. 

 

The scenario is important here for our complete understanding.  Our profession

has had a lot of trouble doing the correct things in the past, largely due to

our anti-establishment mentality.  We want to be artists and not just

technicians.   

 

 

 

Michael W. Bowser, DC, LAc

 

 

 

Chinese Medicine

 

subincor

 

Mon, 22 Jun 2009 16:24:41 +0000

 

Was: Spouse/insurance - Now: Medical Ethics

 

 

 

   

 

           

 

           

 

 

 

     

 

      Hi Joy and all:

 

 

 

This is a troublesome topic, because it is easy to get into this cross-cultural

business. Western Medical ethics are not Chinese Medical ethics. The medical

ethics of a court / imperial doctor were not the ethics of the mendicant taoist

healer.

 

 

 

The ethics of our uptight modern western profession are severely tainted by a

historical influx of scientists from the engineering, physical and chemical

sciences who deeply believed in the separation of the person from the body and

further had an ansolutely abysmal understanding of the human heart and human

warmth. These are the same people who believed animals (including our closest

relatives the apes) to be mere machines with no ability to feel pain or emotion

and who also did not believe that human beings possessed soul. This brought a

deep level of depersonalisation to the modern western field. We see it today in

standard neurology where the direction of causation is bottom up - i.e. the

substrate generates consciousness - consciousness is nothing more than brain

chemicals interacting. These aren't actually " medical " ethics, is what I am

saying.

 

 

 

The chinese, in their deep wisdom, understood that ethics were not about a set

of fixed rules. Witness the famous story regarding the celibate teacher who

broke the rule of not touching women when he picked up a young lady and carried

her across the stream. I hope he was disciplined by his association (turned in,

of course, by his shocked and outraged disciple). This is a great story about

projection and transference and how dangerous fixation and obsession are.

 

 

 

If we talk about ethics in terms of legalism, however, we can find fruitful

territory in terms of the defense and protection of our profession, as well as

about insurance and such.

 

 

 

By the way, it actually slipped my mind, interestingly: I am the primary

caregiver for my father. Turn me in.

 

 

 

I wonder how old family lineage doctors managed the treatment of their families,

especially if they were the only doctor within a day or two's walk? I can't

imagine the classical martial arts scholar doctor not treating his son or

daughter when they were sick as children because " they were his family " . In

fact, I would imagine that it is the parents who would be most deeply familiar

with the subtleties of their children's dynamics and would therefore be the most

prepared to take care of them to best effect.

 

 

 

I also think modern " medical ethics " are an outgrowth of the logistics of a

system where a collision is occurring between insufficient numbers of medical

therapists, the constant and looming threat of litigation, a growing number of

fractured and dysfunctional families and a huge emphasis on the supremacy of the

individual. I mean, kids can send their parents to jail and divorce them and all

manner of unethical stuff. All these issues regarding lack of trust. But we have

psychologists these days to make up for lack of community strength. I'm not sure

if it is working.

 

 

 

Again, I don't see the link between " their " medical ethics and " our " medical

ethics. Interestingly, in latin culture the family takes care of the family. And

if there is a doctor who is not in the family who is taking care of the family,

then that doctor becomes part of the family (how else do you ensure

accountability? interesting).

 

 

 

In my opinion, modern medical ethics are deeply confused and insidiously

damaging to human relationships.

 

 

 

Thoughts?

 

 

 

Hugo

 

 

 

________________________________

 

 

 

Hugo Ramiro

 

 

 

http://middlemedicine.wordpress.com

 

 

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

 

 

Joy Keller <JKellerLAc

 

 

 

Chinese Medicine

 

 

 

Saturday, 20 June, 2009 2:23:30

 

 

 

Re: Spouse/insurance

 

 

 

Medical professional ethics dictate that we should not treat family members

 

 

 

unless it is in an emergency or short-term situation where no other care

 

 

 

provider is available. There is a great online course about our medical

 

 

 

professional ethics at Blue Poppy that details all the reasons why (too long

 

 

 

for an email here) as well as all the other professional ethics to which we

 

 

 

are bound.

 

 

 

Btw, this isn't just about LAc's. This is any doctor in any field not

 

 

 

treating family members.

 

 

 

We (meaning all licensed health care providers) are bound by both legal and

 

 

 

professional ethics. Violations in either arena are grounds for disciplinary

 

 

 

action that could result in the loss of licensure.

 

 

 

I'm not saying that people don't treat their own family members, just that

 

 

 

professional ethics state that we should not (or is it " must " not?).

 

 

 

J

 

 

 

On Fri, Jun 19, 2009 at 8:33 PM, heylaurag <heylaurag (AT) hotmail (DOT) com> wrote:

 

 

 

> Hi, I was wondering if anyone knows if its ok to bill insurance companies

 

 

 

> for treating family members/spouses? I asked a customer service agent at

 

 

 

> AETNA and she said there was no rule against it from AETNA but mentioned

 

 

 

> that there may be an ethical standard in the profession. Anyone know? I

 

 

 

> treat my husband all the time and so it would be nice to be paid for it.

 

 

 

>

 

 

 

> Thanks!

 

 

 

>

 

 

 

> Laura

 

 

 

>

 

 

 

> ____________ _________ _________ _________ ___

 

 

 

Joy Keller, LAc, Dipl.OM

 

 

 

Ramona Acupuncture & Integrative Medicine Clinic

 

 

 

Phone: (760) 654-1040 Fax: (760) 654-4019

 

 

 

www.RamonaAcupunctu re.com

 

 

 

 

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Posted
Posted

Hugo

i think you have a lot of projection here. The only reason that WM is

against this is the fear of inability to stay objective and clear

minded to the detriment of the patient. Never the less MDs treat their

own femilies all the time. With HIPPA you need to give them a written

permission to do so.

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

alonmarcus

 

 

 

 

 

 

 

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Posted
Posted

Hi Alon, So are you saying that we can bill insurance if they sign a permission

slip according to HIPPA?

 

I personally think that there should not be a black or white rule about this.

It should be left in the hands of the patient and pracitioner to decide whether

it is the right choice---knowing that there things to take into consideration

such as objectivity. I think the real problem is that insurance companies would

fear that we would take advantage of the situation and bill for visits to family

members that were not made. Perhaps that is a legitamate concern. However, I

think that rules should not be made based on the small percent of a population

who will cheat the system.

 

So from my point of view I am really only interested in hearing whether or not

it is legal and if I could get in trouble. I don't really want to hear from

people who have assumptions (sorry, I don't mean that to sound rude--I'm just

trying to know the legal answer, not the assumed one)). I want to hear from

people who know the answer for sure. Anyone know for sure?

 

My husband has chronic back pain and frequent sports injuries that are greatly

helped by my treatments. If I wasn't around he would for sure be getting

treatments from someone else who may or may not be as good at helping him.

 

 

 

 

 

 

Chinese Medicine , alon marcus

<alonmarcus wrote:

>

> Hugo

> i think you have a lot of projection here. The only reason that WM is

> against this is the fear of inability to stay objective and clear

> minded to the detriment of the patient. Never the less MDs treat their

> own femilies all the time. With HIPPA you need to give them a written

> permission to do so.

>

>

> 400 29th St. Suite 419

> Oakland Ca 94609

>

>

>

> alonmarcus

 

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Posted
Posted

heylaurag,

 

I think that is what we have been discussing here.

 

We, as doctors/licensed healthcare providers, are held accountable to both

LEGAL and professional (medical) ETHICAL dictates. Both have implications

with regards to disciplinary actions.

 

Because of this duality, we do not have the luxury of simply looking at the

LEGAL side of things while ignoring professional ETHICs to which we are also

bound.

 

It should perhaps be clarified that professional ethics are not the same as

personal ethics - the use of the phrase " professional ethics " is not subject

to personal ideologies of right and wrong. Professional medical ethics

describe a mode of conduct, among other aspects of medical practice, to

which we, as members of that profession, are held accountable.

 

Whether you personally see it a different way, or personally think it should

not be so " black and white " and want it to be left up to the

practitioner...that's not really up to you. That's why we have a

professional code of ethics associated with the practice of medicine.

 

I understand you're trying to get paid for your work and that you feel

entitled to it...but I do feel that what you are asking puts you into both

professional ethical and legal grey-area. Personally, I would choose not to

tread into legal/prof. ethical grey-area by wanting to bill insurance for

services rendered to a family member, but that's just me.

 

However, it seems to me from your response, that the only way you will find

a satisfactory answer (so that you know for sure) is to hire a lawyer versed

in medical practice who will analyze both the legalities and professional

ethics and write an opinion as a result.

 

But, I seriously doubt that anyone on this list could possibly " know for

sure " (unless we have any JD's on here), myself included, because you are

not asking a very simple question. You are asking about something that

involves not just the complexities of the practice of medicine (professional

ethics, licensing boards, federal HIPAA) or the legalities of medial

practice (state laws/regs, which may vary) but also the legalities of

billing insurance (both state and federal laws/regs) and what does or does

not constitute insurance billing fraud. And then there will be individual

insurance companies to which each individual insurance company may or may

not have applied an explicit exclusion in their policies. Two examples that

come to mind:

 

Medicare (Section 2332) has an exclusion for treatment of family members and

will not reimburse physicians (a ref to that section is at

https://www.noridianmedicare.com/p-medb/enroll/general/services_to_relatives.htm\

l)

and defines which relationships are part of this exclusion.

 

BCBS will not reimburse physicians for treatment of family members either.

There are likely others. Aetna, it appears, currently does not. However,

most insurance companies follow in the footsteps of Medicare w/ regards to

policy.

 

Long way back to my original point...which is why I have chosen to refer

back to our professional code of ethics which serve the purpose of keeping

our patients safe and keeping us out of trouble. And professional ethics

state that we should not treat family members unless it is an emergency or

short-term situation. (Even though, as Mike pointed out, that polling

results would seem to indicate that doctors do actually treat family members

despite the ethical dictates).

 

I also agree with Mike that it would be the insurance company that would be

most likely to file a complaint (as one would hope it wouldn't be your

husband;-) If the insurance company feels that you have wrongly billed and

accepted payment from them, they will respond. However, I have seen some

family battles get very ugly...sad...so it would make me extra cautious of

not-so-immediate family members...especially where children are concerned

where one of the two parents might not be so on-board...

 

As an aside, if you haven't read the HIPAA regulations on your own, really

worth doing since it is one of the legal regulations to which we are bound.

Great read for a Saturday morning...not!

 

Ug - well, I think I've run my point into the ground, for what it's worth;

so that's all from me on this.

 

Good luck.

 

J

________

Joy Keller, LAc, Dipl.OM

Ramona Acupuncture & Integrative Medicine Clinic

Phone: (760) 654-1040 Fax: (760) 654-4019

www.RamonaAcupuncture.com

 

 

 

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Posted
Posted

Laura,

If you want to treat him, then do so but do it because you care and then do not

bill any insurance provider for this. No one really cares if you treat him.

The insurance company will blow the whistle on you with your state board while

your husband is not likely to ever file a complaint.

Like I said, it really comes down to the money and the rules are mostly

interconnected with it. Read your ethics clauses in your state statutes or

better yet contact an attorney that understands this.

Michael W. Bowser, DC, LAc

 

Chinese Medicine

heylaurag

Tue, 23 Jun 2009 23:04:42 +0000

Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi Alon, So are you saying that we can bill insurance if they sign a

permission slip according to HIPPA?

 

 

 

I personally think that there should not be a black or white rule about this.

It should be left in the hands of the patient and pracitioner to decide whether

it is the right choice---knowing that there things to take into consideration

such as objectivity. I think the real problem is that insurance companies would

fear that we would take advantage of the situation and bill for visits to family

members that were not made. Perhaps that is a legitamate concern. However, I

think that rules should not be made based on the small percent of a population

who will cheat the system.

 

 

 

So from my point of view I am really only interested in hearing whether or not

it is legal and if I could get in trouble. I don't really want to hear from

people who have assumptions (sorry, I don't mean that to sound rude--I'm just

trying to know the legal answer, not the assumed one)). I want to hear from

people who know the answer for sure. Anyone know for sure?

 

 

 

My husband has chronic back pain and frequent sports injuries that are greatly

helped by my treatments. If I wasn't around he would for sure be getting

treatments from someone else who may or may not be as good at helping him.

 

 

 

Chinese Medicine , alon marcus

<alonmarcus wrote:

 

>

 

> Hugo

 

> i think you have a lot of projection here. The only reason that WM is

 

> against this is the fear of inability to stay objective and clear

 

> minded to the detriment of the patient. Never the less MDs treat their

 

> own femilies all the time. With HIPPA you need to give them a written

 

> permission to do so.

 

>

 

>

 

> 400 29th St. Suite 419

 

> Oakland Ca 94609

 

>

 

>

 

>

 

> alonmarcus

 

>

 

>

 

>

 

>

 

>

 

>

 

>

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Posted
Posted

No i am not talking about insurance. I am talking about allowing the Dr to

communicate with others about health, looking up labs etc. Just writing you

spouse a rx for antibiotic would not require much at all and is done all the

time. Billing would make it very questionable but i don't know what the actual

rules are

 

 

 

 

 

 

 

 

 

 

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Posted
Posted

Great points--thanks Joy. It sounds like the majority of people agree that it

is risky, so I won't take the chance on billing for his treatments.

 

 

Chinese Medicine , Joy Keller <JKellerLAc

wrote:

>

> heylaurag,

>

> I think that is what we have been discussing here.

>

> We, as doctors/licensed healthcare providers, are held accountable to both

> LEGAL and professional (medical) ETHICAL dictates. Both have implications

> with regards to disciplinary actions.

>

> Because of this duality, we do not have the luxury of simply looking at the

> LEGAL side of things while ignoring professional ETHICs to which we are also

> bound.

>

> It should perhaps be clarified that professional ethics are not the same as

> personal ethics - the use of the phrase " professional ethics " is not subject

> to personal ideologies of right and wrong. Professional medical ethics

> describe a mode of conduct, among other aspects of medical practice, to

> which we, as members of that profession, are held accountable.

>

> Whether you personally see it a different way, or personally think it should

> not be so " black and white " and want it to be left up to the

> practitioner...that's not really up to you. That's why we have a

> professional code of ethics associated with the practice of medicine.

>

> I understand you're trying to get paid for your work and that you feel

> entitled to it...but I do feel that what you are asking puts you into both

> professional ethical and legal grey-area. Personally, I would choose not to

> tread into legal/prof. ethical grey-area by wanting to bill insurance for

> services rendered to a family member, but that's just me.

>

> However, it seems to me from your response, that the only way you will find

> a satisfactory answer (so that you know for sure) is to hire a lawyer versed

> in medical practice who will analyze both the legalities and professional

> ethics and write an opinion as a result.

>

> But, I seriously doubt that anyone on this list could possibly " know for

> sure " (unless we have any JD's on here), myself included, because you are

> not asking a very simple question. You are asking about something that

> involves not just the complexities of the practice of medicine (professional

> ethics, licensing boards, federal HIPAA) or the legalities of medial

> practice (state laws/regs, which may vary) but also the legalities of

> billing insurance (both state and federal laws/regs) and what does or does

> not constitute insurance billing fraud. And then there will be individual

> insurance companies to which each individual insurance company may or may

> not have applied an explicit exclusion in their policies. Two examples that

> come to mind:

>

> Medicare (Section 2332) has an exclusion for treatment of family members and

> will not reimburse physicians (a ref to that section is at

>

https://www.noridianmedicare.com/p-medb/enroll/general/services_to_relatives.htm\

l)

> and defines which relationships are part of this exclusion.

>

> BCBS will not reimburse physicians for treatment of family members either.

> There are likely others. Aetna, it appears, currently does not. However,

> most insurance companies follow in the footsteps of Medicare w/ regards to

> policy.

>

> Long way back to my original point...which is why I have chosen to refer

> back to our professional code of ethics which serve the purpose of keeping

> our patients safe and keeping us out of trouble. And professional ethics

> state that we should not treat family members unless it is an emergency or

> short-term situation. (Even though, as Mike pointed out, that polling

> results would seem to indicate that doctors do actually treat family members

> despite the ethical dictates).

>

> I also agree with Mike that it would be the insurance company that would be

> most likely to file a complaint (as one would hope it wouldn't be your

> husband;-) If the insurance company feels that you have wrongly billed and

> accepted payment from them, they will respond. However, I have seen some

> family battles get very ugly...sad...so it would make me extra cautious of

> not-so-immediate family members...especially where children are concerned

> where one of the two parents might not be so on-board...

>

> As an aside, if you haven't read the HIPAA regulations on your own, really

> worth doing since it is one of the legal regulations to which we are bound.

> Great read for a Saturday morning...not!

>

> Ug - well, I think I've run my point into the ground, for what it's worth;

> so that's all from me on this.

>

> Good luck.

>

> J

> ________

> Joy Keller, LAc, Dipl.OM

> Ramona Acupuncture & Integrative Medicine Clinic

> Phone: (760) 654-1040 Fax: (760) 654-4019

> www.RamonaAcupuncture.com

>

>

>

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Posted
Posted

 Hi all and Joy:

 

--Joy-

It should perhaps be clarified that professional ethics are not the same as

personal ethics - the use of the phrase " professional ethics " is not subject

to personal ideologies of right and wrong. Professional medical ethics

describe a mode of conduct, among other aspects of medical practice, to

which we, as members of that profession, are held accountable.

---

 

 The source of all professional ethics are personal ethics, and when a

professional ethic no longer fits a personal ethic, or the personal ethics of a

group of people, the individuals work to change the profession. It is incorrect

to portray professional ethics (especially  " ethics " as related to insurance

billing) as a monolith standing above and beyond the individual, despite the

very real inertia of the system.

 

 I grow weary of policy disputes which consistently annihilate the Chinese

medical profession's diversity and depth. It is understood that some of us are

on the north american continent, bound by its laws and such, and it is

IMPERATIVE that we understand those laws, but to then transpose ethics which are

not ours AS IF THEY WERE is self-destructive.

 

--Joy-

Whether you personally see it a different way, or personally think it should

not be so " black and white " and want it to be left up to the

practitioner. ..that's not really up to you. That's why we have a

professional code of ethics associated with the practice of medicine.

---

 

 The above is disingenuous in that it does not reflect the real, lived

experience of medical practitioners (MDs, for example) who are in a CONSTANT

struggle with the laws that regulate them as they seek to maintain personal (and

professional) autonomy.

 

 It *is* about what we personally believe, in tension with what the profession

decides. This in itself is a huge ethical responsibility.

 

 Hugo

 

 

---

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

 

 

 

 

________________________________

Joy Keller <JKellerLAc

Chinese Medicine

Tuesday, 23 June, 2009 21:20:27

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

heylaurag,

 

I think that is what we have been discussing here.

 

We, as doctors/licensed healthcare providers, are held accountable to both

LEGAL and professional (medical) ETHICAL dictates. Both have implications

with regards to disciplinary actions.

 

Because of this duality, we do not have the luxury of simply looking at the

LEGAL side of things while ignoring professional ETHICs to which we are also

bound.

 

It should perhaps be clarified that professional ethics are not the same as

personal ethics - the use of the phrase " professional ethics " is not subject

to personal ideologies of right and wrong. Professional medical ethics

describe a mode of conduct, among other aspects of medical practice, to

which we, as members of that profession, are held accountablWhether you

personally see it a different way, or personally think it should

not be so " black and white " and want it to be left up to the

practitioner. ..that's not really up to you. That's why we have a

professional code of ethics associated with the practice of medicine.

 

I understand you're trying to get paid for your work and that you feel

entitled to it...but I do feel that what you are asking puts you into both

professional ethical and legal grey-area. Personally, I would choose not to

tread into legal/prof. ethical grey-area by wanting to bill insurance for

services rendered to a family member, but that's just me.

 

However, it seems to me from your response, that the only way you will find

a satisfactory answer (so that you know for sure) is to hire a lawyer versed

in medical practice who will analyze both the legalities and professional

ethics and write an opinion as a result.

 

But, I seriously doubt that anyone on this list could possibly " know for

sure " (unless we have any JD's on here), myself included, because you are

not asking a very simple question. You are asking about something that

involves not just the complexities of the practice of medicine (professional

ethics, licensing boards, federal HIPAA) or the legalities of medial

practice (state laws/regs, which may vary) but also the legalities of

billing insurance (both state and federal laws/regs) and what does or does

not constitute insurance billing fraud. And then there will be individual

insurance companies to which each individual insurance company may or may

not have applied an explicit exclusion in their policies. Two examples that

come to mind:

 

Medicare (Section 2332) has an exclusion for treatment of family members and

will not reimburse physicians (a ref to that section is at

https://www. noridianmedicare .com/p-medb/ enroll/general/ services_

to_relatives. html)

and defines which relationships are part of this exclusion.

 

BCBS will not reimburse physicians for treatment of family members either.

There are likely others. Aetna, it appears, currently does not. However,

most insurance companies follow in the footsteps of Medicare w/ regards to

policy.

 

Long way back to my original point...which is why I have chosen to refer

back to our professional code of ethics which serve the purpose of keeping

our patients safe and keeping us out of trouble. And professional ethics

state that we should not treat family members unless it is an emergency or

short-term situation. (Even though, as Mike pointed out, that polling

results would seem to indicate that doctors do actually treat family members

despite the ethical dictates).

 

I also agree with Mike that it would be the insurance company that would be

most likely to file a complaint (as one would hope it wouldn't be your

husband;-) If the insurance company feels that you have wrongly billed and

accepted payment from them, they will respond. However, I have seen some

family battles get very ugly...sad.. .so it would make me extra cautious of

not-so-immediate family members...especiall y where children are concerned

where one of the two parents might not be so on-board...

 

As an aside, if you haven't read the HIPAA regulations on your own, really

worth doing since it is one of the legal regulations to which we are bound.

Great read for a Saturday morning...not!

 

Ug - well, I think I've run my point into the ground, for what it's worth;

so that's all from me on this.

 

Good luck.

 

J

____________ _________ _________ _________ ___

Joy Keller, LAc, Dipl.OM

Ramona Acupuncture & Integrative Medicine Clinic

Phone: (760) 654-1040 Fax: (760) 654-4019

www.RamonaAcupunctu re.com

 

 

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Posted
Posted

Hugo,

When practitioners take it upon themselves to disregard the professional norms,

they set themselves up for legal problems. In other healthcare professions,

individuality or creativity can be dangerous to one's practice with more then a

few serving jail time. I can provide many examples from independent contractor

relationships (not really legal in healthcare) to new techniques for cures

(decompression therapy). In each case, these are new ideas, yet they are

sometimes so radical in application that people are found to violate the norms.

In many such cases, people are found guilty of a crime and some go to jail. I

have often told my students, that in healthcare you do not want to be the

trend-setter.

 

Michael W. Bowser, DC, LAc

 

Chinese Medicine

subincor

Thu, 25 Jun 2009 17:35:10 +0000

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi all and Joy:

 

 

 

--Joy-

 

It should perhaps be clarified that professional ethics are not the same as

 

personal ethics - the use of the phrase " professional ethics " is not subject

 

to personal ideologies of right and wrong. Professional medical ethics

 

describe a mode of conduct, among other aspects of medical practice, to

 

which we, as members of that profession, are held accountable.

 

---

 

 

 

The source of all professional ethics are personal ethics, and when a

professional ethic no longer fits a personal ethic, or the personal ethics of a

group of people, the individuals work to change the profession. It is incorrect

to portray professional ethics (especially " ethics " as related to insurance

billing) as a monolith standing above and beyond the individual, despite the

very real inertia of the system.

 

 

 

I grow weary of policy disputes which consistently annihilate the Chinese

medical profession's diversity and depth. It is understood that some of us are

on the north american continent, bound by its laws and such, and it is

IMPERATIVE that we understand those laws, but to then transpose ethics which are

not ours AS IF THEY WERE is self-destructive.

 

 

 

--Joy-

 

Whether you personally see it a different way, or personally think it should

 

not be so " black and white " and want it to be left up to the

 

practitioner. ..that's not really up to you. That's why we have a

 

professional code of ethics associated with the practice of medicine.

 

---

 

 

 

The above is disingenuous in that it does not reflect the real, lived

experience of medical practitioners (MDs, for example) who are in a CONSTANT

struggle with the laws that regulate them as they seek to maintain personal (and

professional) autonomy.

 

 

 

It *is* about what we personally believe, in tension with what the profession

decides. This in itself is a huge ethical responsibility.

 

 

 

Hugo

 

 

 

---

 

 

 

________________________________

 

Hugo Ramiro

 

http://middlemedicine.wordpress.com

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

Joy Keller <JKellerLAc

 

Chinese Medicine

 

Tuesday, 23 June, 2009 21:20:27

 

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

heylaurag,

 

 

 

I think that is what we have been discussing here.

 

 

 

We, as doctors/licensed healthcare providers, are held accountable to both

 

LEGAL and professional (medical) ETHICAL dictates. Both have implications

 

with regards to disciplinary actions.

 

 

 

Because of this duality, we do not have the luxury of simply looking at the

 

LEGAL side of things while ignoring professional ETHICs to which we are also

 

bound.

 

 

 

It should perhaps be clarified that professional ethics are not the same as

 

personal ethics - the use of the phrase " professional ethics " is not subject

 

to personal ideologies of right and wrong. Professional medical ethics

 

describe a mode of conduct, among other aspects of medical practice, to

 

which we, as members of that profession, are held accountablWhether you

personally see it a different way, or personally think it should

 

not be so " black and white " and want it to be left up to the

 

practitioner. ..that's not really up to you. That's why we have a

 

professional code of ethics associated with the practice of medicine.

 

 

 

I understand you're trying to get paid for your work and that you feel

 

entitled to it...but I do feel that what you are asking puts you into both

 

professional ethical and legal grey-area. Personally, I would choose not to

 

tread into legal/prof. ethical grey-area by wanting to bill insurance for

 

services rendered to a family member, but that's just me.

 

 

 

However, it seems to me from your response, that the only way you will find

 

a satisfactory answer (so that you know for sure) is to hire a lawyer versed

 

in medical practice who will analyze both the legalities and professional

 

ethics and write an opinion as a result.

 

 

 

But, I seriously doubt that anyone on this list could possibly " know for

 

sure " (unless we have any JD's on here), myself included, because you are

 

not asking a very simple question. You are asking about something that

 

involves not just the complexities of the practice of medicine (professional

 

ethics, licensing boards, federal HIPAA) or the legalities of medial

 

practice (state laws/regs, which may vary) but also the legalities of

 

billing insurance (both state and federal laws/regs) and what does or does

 

not constitute insurance billing fraud. And then there will be individual

 

insurance companies to which each individual insurance company may or may

 

not have applied an explicit exclusion in their policies. Two examples that

 

come to mind:

 

 

 

Medicare (Section 2332) has an exclusion for treatment of family members and

 

will not reimburse physicians (a ref to that section is at

 

https://www. noridianmedicare .com/p-medb/ enroll/general/ services_

to_relatives. html)

 

and defines which relationships are part of this exclusion.

 

 

 

BCBS will not reimburse physicians for treatment of family members either.

 

There are likely others. Aetna, it appears, currently does not. However,

 

most insurance companies follow in the footsteps of Medicare w/ regards to

 

policy.

 

 

 

Long way back to my original point...which is why I have chosen to refer

 

back to our professional code of ethics which serve the purpose of keeping

 

our patients safe and keeping us out of trouble. And professional ethics

 

state that we should not treat family members unless it is an emergency or

 

short-term situation. (Even though, as Mike pointed out, that polling

 

results would seem to indicate that doctors do actually treat family members

 

despite the ethical dictates).

 

 

 

I also agree with Mike that it would be the insurance company that would be

 

most likely to file a complaint (as one would hope it wouldn't be your

 

husband;-) If the insurance company feels that you have wrongly billed and

 

accepted payment from them, they will respond. However, I have seen some

 

family battles get very ugly...sad.. .so it would make me extra cautious of

 

not-so-immediate family members...especiall y where children are concerned

 

where one of the two parents might not be so on-board...

 

 

 

As an aside, if you haven't read the HIPAA regulations on your own, really

 

worth doing since it is one of the legal regulations to which we are bound.

 

Great read for a Saturday morning...not!

 

 

 

Ug - well, I think I've run my point into the ground, for what it's worth;

 

so that's all from me on this.

 

 

 

Good luck.

 

 

 

J

 

____________ _________ _________ _________ ___

 

Joy Keller, LAc, Dipl.OM

 

Ramona Acupuncture & Integrative Medicine Clinic

 

Phone: (760) 654-1040 Fax: (760) 654-4019

 

www.RamonaAcupunctu re.com

 

 

 

 

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Posted
Posted

 Hi Mike,

 Your points are valid and conservative. Risks are the norm for setting a new

standard or direction. This in itself should not be a deterrent for someone who

is sure of themselves and what they are doing - pioneers in every field have

known the inherent dangers.

 My point stands that ethics and laws are not immutable, and that the driving

power for their change lies with individuals, and groups of individuals.

 It is IMPERATIVE to know and understand local laws and professional codes of

conduct. It is *also* an ethical imperative to know when and how to work to

change the system.

 As the saying goes, slow change is safe and fast change is dangerous.

 

 Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

 

 

 

 

________________________________

mike Bowser <naturaldoc1

Chinese Traditional Medicine

Thursday, 25 June, 2009 14:46:02

RE: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

Hugo,

When practitioners take it upon themselves to disregard the professional norms,

they set themselves up for legal problems.  In other healthcare professions,

individuality or creativity can be dangerous to one's practice with more then a

few serving jail time.  I can provide many examples from independent contractor

relationships (not really legal in healthcare) to new techniques for cures

(decompression therapy).  In each case, these are new ideas, yet they are

sometimes so radical in application that people are found to violate the

norms.  In many such cases, people are found guilty of a crime and some go to

jail.  I have often told my students, that in healthcare you do not want to be

the trend-setter. 

 

Michael W. Bowser, DC, LAc

 

Chinese Medicine

subincor

Thu, 25 Jun 2009 17:35:10 +0000

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

           

           

 

 

     

      Hi all and Joy:

 

 

 

--Joy-

 

It should perhaps be clarified that professional ethics are not the same as

 

personal ethics - the use of the phrase " professional ethics " is not subject

 

to personal ideologies of right and wrong. Professional medical ethics

 

describe a mode of conduct, among other aspects of medical practice, to

 

which we, as members of that profession, are held accountable.

 

---

 

 

 

The source of all professional ethics are personal ethics, and when a

professional ethic no longer fits a personal ethic, or the personal ethics of a

group of people, the individuals work to change the profession. It is incorrect

to portray professional ethics (especially " ethics " as related to insurance

billing) as a monolith standing above and beyond the individual, despite the

very real inertia of the system.

 

 

 

I grow weary of policy disputes which consistently annihilate the Chinese

medical profession's diversity and depth. It is understood that some of us are

on the north american continent, bound by its laws and such, and it is

IMPERATIVE that we understand those laws, but to then transpose ethics which are

not ours AS IF THEY WERE is self-destructive.

 

 

 

--Joy-

 

Whether you personally see it a different way, or personally think it should

 

not be so " black and white " and want it to be left up to the

 

practitioner. ..that's not really up to you. That's why we have a

 

professional code of ethics associated with the practice of medicine.

 

---

 

 

 

The above is disingenuous in that it does not reflect the real, lived experience

of medical practitioners (MDs, for example) who are in a CONSTANT struggle with

the laws that regulate them as they seek to maintain personal (and professional)

autonomy.

 

 

 

It *is* about what we personally believe, in tension with what the profession

decides. This in itself is a huge ethical responsibility.

 

 

 

Hugo

 

 

 

---

 

 

 

________________________________

 

Hugo Ramiro

 

http://middlemedicine.wordpress.com

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

Joy Keller <JKellerLAc

 

Chinese Medicine

 

Tuesday, 23 June, 2009 21:20:27

 

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

heylaurag,

 

 

 

I think that is what we have been discussing here.

 

 

 

We, as doctors/licensed healthcare providers, are held accountable to both

 

LEGAL and professional (medical) ETHICAL dictates. Both have implications

 

with regards to disciplinary actions.

 

 

 

Because of this duality, we do not have the luxury of simply looking at the

 

LEGAL side of things while ignoring professional ETHICs to which we are also

 

bound.

 

 

 

It should perhaps be clarified that professional ethics are not the same as

 

personal ethics - the use of the phrase " professional ethics " is not subject

 

to personal ideologies of right and wrong. Professional medical ethics

 

describe a mode of conduct, among other aspects of medical practice, to

 

which we, as members of that profession, are held accountablWhether you

personally see it a different way, or personally think it should

 

not be so " black and white " and want it to be left up to the

 

practitioner. ..that's not really up to you. That's why we have a

 

professional code of ethics associated with the practice of medicine.

 

 

 

I understand you're trying to get paid for your work and that you feel

 

entitled to it...but I do feel that what you are asking puts you into both

 

professional ethical and legal grey-area. Personally, I would choose not to

 

tread into legal/prof. ethical grey-area by wanting to bill insurance for

 

services rendered to a family member, but that's just me.

 

 

 

However, it seems to me from your response, that the only way you will find

 

a satisfactory answer (so that you know for sure) is to hire a lawyer versed

 

in medical practice who will analyze both the legalities and professional

 

ethics and write an opinion as a result.

 

 

 

But, I seriously doubt that anyone on this list could possibly " know for

 

sure " (unless we have any JD's on here), myself included, because you are

 

not asking a very simple question. You are asking about something that

 

involves not just the complexities of the practice of medicine (professional

 

ethics, licensing boards, federal HIPAA) or the legalities of medial

 

practice (state laws/regs, which may vary) but also the legalities of

 

billing insurance (both state and federal laws/regs) and what does or does

 

not constitute insurance billing fraud. And then there will be individual

 

insurance companies to which each individual insurance company may or may

 

not have applied an explicit exclusion in their policies. Two examples that

 

come to mind:

 

 

 

Medicare (Section 2332) has an exclusion for treatment of family members and

 

will not reimburse physicians (a ref to that section is at

 

https://www. noridianmedicare .com/p-medb/ enroll/general/ services_

to_relatives. html)

 

and defines which relationships are part of this exclusion.

 

 

 

BCBS will not reimburse physicians for treatment of family members either.

 

There are likely others. Aetna, it appears, currently does not. However,

 

most insurance companies follow in the footsteps of Medicare w/ regards to

 

policy.

 

 

 

Long way back to my original point...which is why I have chosen to refer

 

back to our professional code of ethics which serve the purpose of keeping

 

our patients safe and keeping us out of trouble. And professional ethics

 

state that we should not treat family members unless it is an emergency or

 

short-term situation. (Even though, as Mike pointed out, that polling

 

results would seem to indicate that doctors do actually treat family members

 

despite the ethical dictates).

 

 

 

I also agree with Mike that it would be the insurance company that would be

 

most likely to file a complaint (as one would hope it wouldn't be your

 

husband;-) If the insurance company feels that you have wrongly billed and

 

accepted payment from them, they will respond. However, I have seen some

 

family battles get very ugly...sad.. .so it would make me extra cautious of

 

not-so-immediate family members...especiall y where children are concerned

 

where one of the two parents might not be so on-board...

 

 

 

As an aside, if you haven't read the HIPAA regulations on your own, really

 

worth doing since it is one of the legal regulations to which we are bound.

 

Great read for a Saturday morning...not!

 

 

 

Ug - well, I think I've run my point into the ground, for what it's worth;

 

so that's all from me on this.

 

 

 

Good luck.

 

 

 

J

 

____________ _________ _________ _________ ___

 

Joy Keller, LAc, Dipl.OM

 

Ramona Acupuncture & Integrative Medicine Clinic

 

Phone: (760) 654-1040 Fax: (760) 654-4019

 

www.RamonaAcupunctu re.com

 

 

 

 

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Posted
Posted

Hugo,

Conservative maybe but applicable. It has always amazed me when I hear from

other LAc's at seminars that do not seem to understand these differences you

mention nor the legal obligations we have. The only obligations we must follow

are the legal ones, as they have teeth if you do not. I feel that it is only a

matter of time and we will start to read more and more about them in the news.

 

Michael W. Bowser, DC, LAc

 

 

Chinese Medicine

subincor

Thu, 25 Jun 2009 19:01:16 +0000

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi Mike,

 

Your points are valid and conservative. Risks are the norm for setting a new

standard or direction. This in itself should not be a deterrent for someone who

is sure of themselves and what they are doing - pioneers in every field have

known the inherent dangers.

 

My point stands that ethics and laws are not immutable, and that the driving

power for their change lies with individuals, and groups of individuals.

 

It is IMPERATIVE to know and understand local laws and professional codes of

conduct. It is *also* an ethical imperative to know when and how to work to

change the system.

 

As the saying goes, slow change is safe and fast change is dangerous.

 

 

 

Hugo

 

________________________________

 

Hugo Ramiro

 

http://middlemedicine.wordpress.com

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

mike Bowser <naturaldoc1

 

Chinese Traditional Medicine

 

Thursday, 25 June, 2009 14:46:02

 

RE: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

Hugo,

 

When practitioners take it upon themselves to disregard the professional norms,

they set themselves up for legal problems. In other healthcare professions,

individuality or creativity can be dangerous to one's practice with more then a

few serving jail time. I can provide many examples from independent contractor

relationships (not really legal in healthcare) to new techniques for cures

(decompression therapy). In each case, these are new ideas, yet they are

sometimes so radical in application that people are found to violate the norms.

In many such cases, people are found guilty of a crime and some go to jail. I

have often told my students, that in healthcare you do not want to be the

trend-setter.

 

 

 

Michael W. Bowser, DC, LAc

 

 

 

Chinese Medicine

 

subincor

 

Thu, 25 Jun 2009 17:35:10 +0000

 

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi all and Joy:

 

 

 

--Joy-

 

 

 

It should perhaps be clarified that professional ethics are not the same as

 

 

 

personal ethics - the use of the phrase " professional ethics " is not subject

 

 

 

to personal ideologies of right and wrong. Professional medical ethics

 

 

 

describe a mode of conduct, among other aspects of medical practice, to

 

 

 

which we, as members of that profession, are held accountable.

 

 

 

---

 

 

 

The source of all professional ethics are personal ethics, and when a

professional ethic no longer fits a personal ethic, or the personal ethics of a

group of people, the individuals work to change the profession. It is incorrect

to portray professional ethics (especially " ethics " as related to insurance

billing) as a monolith standing above and beyond the individual, despite the

very real inertia of the system.

 

 

 

I grow weary of policy disputes which consistently annihilate the Chinese

medical profession's diversity and depth. It is understood that some of us are

on the north american continent, bound by its laws and such, and it is

IMPERATIVE that we understand those laws, but to then transpose ethics which are

not ours AS IF THEY WERE is self-destructive.

 

 

 

--Joy-

 

 

 

Whether you personally see it a different way, or personally think it should

 

 

 

not be so " black and white " and want it to be left up to the

 

 

 

practitioner. ..that's not really up to you. That's why we have a

 

 

 

professional code of ethics associated with the practice of medicine.

 

 

 

---

 

 

 

The above is disingenuous in that it does not reflect the real, lived experience

of medical practitioners (MDs, for example) who are in a CONSTANT struggle with

the laws that regulate them as they seek to maintain personal (and professional)

autonomy.

 

 

 

It *is* about what we personally believe, in tension with what the profession

decides. This in itself is a huge ethical responsibility.

 

 

 

Hugo

 

 

 

---

 

 

 

________________________________

 

 

 

Hugo Ramiro

 

 

 

http://middlemedicine.wordpress.com

 

 

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

 

 

Joy Keller <JKellerLAc

 

 

 

Chinese Medicine

 

 

 

Tuesday, 23 June, 2009 21:20:27

 

 

 

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

heylaurag,

 

 

 

I think that is what we have been discussing here.

 

 

 

We, as doctors/licensed healthcare providers, are held accountable to both

 

 

 

LEGAL and professional (medical) ETHICAL dictates. Both have implications

 

 

 

with regards to disciplinary actions.

 

 

 

Because of this duality, we do not have the luxury of simply looking at the

 

 

 

LEGAL side of things while ignoring professional ETHICs to which we are also

 

 

 

bound.

 

 

 

It should perhaps be clarified that professional ethics are not the same as

 

 

 

personal ethics - the use of the phrase " professional ethics " is not subject

 

 

 

to personal ideologies of right and wrong. Professional medical ethics

 

 

 

describe a mode of conduct, among other aspects of medical practice, to

 

 

 

which we, as members of that profession, are held accountablWhether you

personally see it a different way, or personally think it should

 

 

 

not be so " black and white " and want it to be left up to the

 

 

 

practitioner. ..that's not really up to you. That's why we have a

 

 

 

professional code of ethics associated with the practice of medicine.

 

 

 

I understand you're trying to get paid for your work and that you feel

 

 

 

entitled to it...but I do feel that what you are asking puts you into both

 

 

 

professional ethical and legal grey-area. Personally, I would choose not to

 

 

 

tread into legal/prof. ethical grey-area by wanting to bill insurance for

 

 

 

services rendered to a family member, but that's just me.

 

 

 

However, it seems to me from your response, that the only way you will find

 

 

 

a satisfactory answer (so that you know for sure) is to hire a lawyer versed

 

 

 

in medical practice who will analyze both the legalities and professional

 

 

 

ethics and write an opinion as a result.

 

 

 

But, I seriously doubt that anyone on this list could possibly " know for

 

 

 

sure " (unless we have any JD's on here), myself included, because you are

 

 

 

not asking a very simple question. You are asking about something that

 

 

 

involves not just the complexities of the practice of medicine (professional

 

 

 

ethics, licensing boards, federal HIPAA) or the legalities of medial

 

 

 

practice (state laws/regs, which may vary) but also the legalities of

 

 

 

billing insurance (both state and federal laws/regs) and what does or does

 

 

 

not constitute insurance billing fraud. And then there will be individual

 

 

 

insurance companies to which each individual insurance company may or may

 

 

 

not have applied an explicit exclusion in their policies. Two examples that

 

 

 

come to mind:

 

 

 

Medicare (Section 2332) has an exclusion for treatment of family members and

 

 

 

will not reimburse physicians (a ref to that section is at

 

 

 

https://www. noridianmedicare .com/p-medb/ enroll/general/ services_

to_relatives. html)

 

 

 

and defines which relationships are part of this exclusion.

 

 

 

BCBS will not reimburse physicians for treatment of family members either.

 

 

 

There are likely others. Aetna, it appears, currently does not. However,

 

 

 

most insurance companies follow in the footsteps of Medicare w/ regards to

 

 

 

policy.

 

 

 

Long way back to my original point...which is why I have chosen to refer

 

 

 

back to our professional code of ethics which serve the purpose of keeping

 

 

 

our patients safe and keeping us out of trouble. And professional ethics

 

 

 

state that we should not treat family members unless it is an emergency or

 

 

 

short-term situation. (Even though, as Mike pointed out, that polling

 

 

 

results would seem to indicate that doctors do actually treat family members

 

 

 

despite the ethical dictates).

 

 

 

I also agree with Mike that it would be the insurance company that would be

 

 

 

most likely to file a complaint (as one would hope it wouldn't be your

 

 

 

husband;-) If the insurance company feels that you have wrongly billed and

 

 

 

accepted payment from them, they will respond. However, I have seen some

 

 

 

family battles get very ugly...sad.. .so it would make me extra cautious of

 

 

 

not-so-immediate family members...especiall y where children are concerned

 

 

 

where one of the two parents might not be so on-board...

 

 

 

As an aside, if you haven't read the HIPAA regulations on your own, really

 

 

 

worth doing since it is one of the legal regulations to which we are bound.

 

 

 

Great read for a Saturday morning...not!

 

 

 

Ug - well, I think I've run my point into the ground, for what it's worth;

 

 

 

so that's all from me on this.

 

 

 

Good luck.

 

 

 

J

 

 

 

____________ _________ _________ _________ ___

 

 

 

Joy Keller, LAc, Dipl.OM

 

 

 

Ramona Acupuncture & Integrative Medicine Clinic

 

 

 

Phone: (760) 654-1040 Fax: (760) 654-4019

 

 

 

www.RamonaAcupunctu re.com

 

 

 

 

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Posted
Posted

Laura:

 

 

 

I have been following this thread and can come up with these summary points:

 

 

 

1.  I would not bill insurance for treating my family.  Would not touch that

with a 10 foot pole.

 

 

 

2.  I would treat my family - as I am the closest most convenient person, and

sometimes the most competent to do it.

 

 

 

3.  I send my family members to other practiitoners when it makes sense to do

so - when someone else's treatment would benefit them more, either physically or

psychologically.

 

 

 

Hope this helps.

 

 

 

Take Care,

 

 

 

Anne

 

 

 

 

 

 

 

Anne C. Crowley, L.Ac., Dipl.Ac.

www.LaPlataAcupuncture.com

 

-

" heylaurag " <heylaurag

" Traditional "

<Chinese Medicine >

Wednesday, June 24, 2009 6:24:28 PM GMT -05:00 US/Canada Eastern

Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

Great points--thanks Joy. It sounds like the majority of people agree that it is

risky, so I won't take the chance on billing for his treatments.

 

Chinese Medicine , Joy Keller

<JKellerLAc wrote:

>

> heylaurag,

>

> I think that is what we have been discussing here.

>

> We, as doctors/licensed healthcare providers, are held accountable to both

> LEGAL and professional (medical) ETHICAL dictates. Both have implications

> with regards to disciplinary actions.

>

> Because of this duality, we do not have the luxury of simply looking at the

> LEGAL side of things while ignoring professional ETHICs to which we are also

> bound.

>

> It should perhaps be clarified that professional ethics are not the same as

> personal ethics - the use of the phrase " professional ethics " is not subject

> to personal ideologies of right and wrong. Professional medical ethics

> describe a mode of conduct, among other aspects of medical practice, to

> which we, as members of that profession, are held accountable.

>

> Whether you personally see it a different way, or personally think it should

> not be so " black and white " and want it to be left up to the

> practitioner...that's not really up to you. That's why we have a

> professional code of ethics associated with the practice of medicine.

>

> I understand you're trying to get paid for your work and that you feel

> entitled to it...but I do feel that what you are asking puts you into both

> professional ethical and legal grey-area. Personally, I would choose not to

> tread into legal/prof. ethical grey-area by wanting to bill insurance for

> services rendered to a family member, but that's just me.

>

> However, it seems to me from your response, that the only way you will find

> a satisfactory answer (so that you know for sure) is to hire a lawyer versed

> in medical practice who will analyze both the legalities and professional

> ethics and write an opinion as a result.

>

> But, I seriously doubt that anyone on this list could possibly " know for

> sure " (unless we have any JD's on here), myself included, because you are

> not asking a very simple question. You are asking about something that

> involves not just the complexities of the practice of medicine (professional

> ethics, licensing boards, federal HIPAA) or the legalities of medial

> practice (state laws/regs, which may vary) but also the legalities of

> billing insurance (both state and federal laws/regs) and what does or does

> not constitute insurance billing fraud. And then there will be individual

> insurance companies to which each individual insurance company may or may

> not have applied an explicit exclusion in their policies. Two examples that

> come to mind:

>

> Medicare (Section 2332) has an exclusion for treatment of family members and

> will not reimburse physicians (a ref to that section is at

>

https://www.noridianmedicare.com/p-medb/enroll/general/services_to_relatives.htm\

l )

> and defines which relationships are part of this exclusion.

>

> BCBS will not reimburse physicians for treatment of family members either.

> There are likely others. Aetna, it appears, currently does not. However,

> most insurance companies follow in the footsteps of Medicare w/ regards to

> policy.

>

> Long way back to my original point...which is why I have chosen to refer

> back to our professional code of ethics which serve the purpose of keeping

> our patients safe and keeping us out of trouble. And professional ethics

> state that we should not treat family members unless it is an emergency or

> short-term situation. (Even though, as Mike pointed out, that polling

> results would seem to indicate that doctors do actually treat family members

> despite the ethical dictates).

>

> I also agree with Mike that it would be the insurance company that would be

> most likely to file a complaint (as one would hope it wouldn't be your

> husband;-) If the insurance company feels that you have wrongly billed and

> accepted payment from them, they will respond. However, I have seen some

> family battles get very ugly...sad...so it would make me extra cautious of

> not-so-immediate family members...especially where children are concerned

> where one of the two parents might not be so on-board...

>

> As an aside, if you haven't read the HIPAA regulations on your own, really

> worth doing since it is one of the legal regulations to which we are bound.

> Great read for a Saturday morning...not!

>

> Ug - well, I think I've run my point into the ground, for what it's worth;

> so that's all from me on this.

>

> Good luck.

>

> J

> ________

> Joy Keller, LAc, Dipl.OM

> Ramona Acupuncture & Integrative Medicine Clinic

> Phone: (760) 654-1040 Fax: (760) 654-4019

> www.RamonaAcupuncture.com

>

>

>

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Posted
Posted

For what it is worth....I agree with Mike.

 

As for " knowing " your state's Laws & Rules......here in Florida, AP

licensees are required to study every two years at least 2 hours of continuing

education. That's never enough and the practitioners pay little attention for

the most part because who wants to study and know the laws & rules.

 

Having been forced to become a pro se litigant, I can say that all the

nuances get very interesting and tricky.... but of course that's what law is

all about (the twists and turns depending on who is telling/pleading the

story). Laws and rules appear to be purposefully constructed vague just so

lawyers and the many state Bars have their cottage industry of litigation to

bleed the clients.

 

Mike.......the discussion(s) in the past regarding the doctor " titles " was

recently resolved (at least for the moment) in Florida. After eleven years

of battle, the Assistant Attorney General assigned to the Florida Board of

Acupuncture admitted and agreed at an official meeting/hearing that Florida

AP licensees can call themselves " doctor " . This is a two way street. Of

course with the law & rules there are always caveats. The Administrative Code

Rule which we were instrumental in getting adopted in Sept. 2006 has all

those twists and turns that a practitioner MUST follow to be free of the

charges of fraud and deception in their use of the title " doctor " . Ultimately

there will be practitioners who will be prosecuted for the improper use

just because they do not understand what is plainly written

...........primarily because they fail to use common sense.

 

Unfortunately experienced pro se litigants cannot advise

others......otherwise they would be practicing law without a Bar ticket (so

called license)

and could be prosecuted for that high crime....lol.

 

Knowing the law oneself is not that difficult but it does take some effort

and time....and well worth it.

 

Lots of money and hiring lawyers are not often the answer. The system

controls the lawyers and more often than not they are not the most

informed.....I have seen this to be very true needing to fire my lawyer(s) and

take

over my own cases. Either they are ignorant or purposefully ignorant. One of

the downsides of hiring a lawyer is that once you do.....you have just signed

over your fate by power of attorney to whatever they do.

 

Practical and common sense comments appear to be the order of the day.

 

Richard

 

 

 

In a message dated 06/26/09 11:31:06 A.M. Eastern Daylight Time,

subincor writes:

 

You put it very well when you say that " we must follow legal obligations

as they have teeth if we do not " . I have felt for a long time that we need

more lawyers and money on our side. Shall we all start playing the lottery?

haha.

 

What are some of the issues we may start reading about?

 

Thanks,

Hugo

 

 

**************Make your summer sizzle with fast and easy recipes for the

grill. (http://food.aol.com/grilling?ncid=emlcntusfood00000005)

 

 

 

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Posted
Posted

 Hi Mike:

 

  " Conservative " is not a pejorative term, it is a stance which has its

beneficial aspects and its detractions.

 It is the stance we can default to and then move away from intelligently and

wisely, defaulting back to our conservative starting point frequently. That's

one way to do it anyway.

 

 You put it very well when you say that " we must follow legal obligations as

they have teeth if we do not " . I have felt for a long time that we need more

lawyers and money on our side. Shall we all start playing the lottery? haha.

 

 What are some of the issues we may start reading about?

 

 Thanks,

 Hugo

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

 

 

 

 

________________________________

mike Bowser <naturaldoc1

Chinese Traditional Medicine

Thursday, 25 June, 2009 21:34:50

RE: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

Hugo,

Conservative maybe but applicable.  It has always amazed me when I hear from

other LAc's at seminars that do not seem to understand these differences you

mention nor the legal obligations we have.  The only obligations we must follow

are the legal ones, as they have teeth if you do not.  I feel that it is only a

matter of time and we will start to read more and more about them in the news. 

 

Michael W. Bowser, DC, LAc

 

 

Chinese Medicine

subincor

Thu, 25 Jun 2009 19:01:16 +0000

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

           

           

 

 

     

      Hi Mike,

 

Your points are valid and conservative. Risks are the norm for setting a new

standard or direction. This in itself should not be a deterrent for someone who

is sure of themselves and what they are doing - pioneers in every field have

known the inherent dangers.

 

My point stands that ethics and laws are not immutable, and that the driving

power for their change lies with individuals, and groups of individuals.

 

It is IMPERATIVE to know and understand local laws and professional codes of

conduct. It is *also* an ethical imperative to know when and how to work to

change the system.

 

As the saying goes, slow change is safe and fast change is dangerous.

 

 

 

Hugo

 

________________________________

 

Hugo Ramiro

 

http://middlemedicine.wordpress.com

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

mike Bowser <naturaldoc1

 

Chinese Traditional Medicine

 

Thursday, 25 June, 2009 14:46:02

 

RE: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

Hugo,

 

When practitioners take it upon themselves to disregard the professional norms,

they set themselves up for legal problems.  In other healthcare professions,

individuality or creativity can be dangerous to one's practice with more then a

few serving jail time.  I can provide many examples from independent contractor

relationships (not really legal in healthcare) to new techniques for cures

(decompression therapy).  In each case, these are new ideas, yet they are

sometimes so radical in application that people are found to violate the

norms.  In many such cases, people are found guilty of a crime and some go to

jail.  I have often told my students, that in healthcare you do not want to be

the trend-setter. 

 

 

 

Michael W. Bowser, DC, LAc

 

 

 

Chinese Medicine

 

subincor

 

Thu, 25 Jun 2009 17:35:10 +0000

 

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

   

 

           

 

           

 

 

 

     

 

      Hi all and Joy:

 

 

 

--Joy-

 

 

 

It should perhaps be clarified that professional ethics are not the same as

 

 

 

personal ethics - the use of the phrase " professional ethics " is not subject

 

 

 

to personal ideologies of right and wrong. Professional medical ethics

 

 

 

describe a mode of conduct, among other aspects of medical practice, to

 

 

 

which we, as members of that profession, are held accountable.

 

 

 

---

 

 

 

The source of all professional ethics are personal ethics, and when a

professional ethic no longer fits a personal ethic, or the personal ethics of a

group of people, the individuals work to change the profession. It is incorrect

to portray professional ethics (especially " ethics " as related to insurance

billing) as a monolith standing above and beyond the individual, despite the

very real inertia of the system.

 

 

 

I grow weary of policy disputes which consistently annihilate the Chinese

medical profession's diversity and depth. It is understood that some of us are

on the north american continent, bound by its laws and such, and it is

IMPERATIVE that we understand those laws, but to then transpose ethics which are

not ours AS IF THEY WERE is self-destructive.

 

 

 

--Joy-

 

 

 

Whether you personally see it a different way, or personally think it should

 

 

 

not be so " black and white " and want it to be left up to the

 

 

 

practitioner. ..that's not really up to you. That's why we have a

 

 

 

professional code of ethics associated with the practice of medicine.

 

 

 

---

 

 

 

The above is disingenuous in that it does not reflect the real, lived experience

of medical practitioners (MDs, for example) who are in a CONSTANT struggle with

the laws that regulate them as they seek to maintain personal (and professional)

autonomy.

 

 

 

It *is* about what we personally believe, in tension with what the profession

decides. This in itself is a huge ethical responsibility.

 

 

 

Hugo

 

 

 

---

 

 

 

________________________________

 

 

 

Hugo Ramiro

 

 

 

http://middlemedicine.wordpress.com

 

 

 

http://www.chinesemedicaltherapies.org

 

 

 

________________________________

 

 

 

Joy Keller <JKellerLAc

 

 

 

Chinese Medicine

 

 

 

Tuesday, 23 June, 2009 21:20:27

 

 

 

Re: Re:Was: Spouse/insurance - Now: Medical Ethics

 

 

 

heylaurag,

 

 

 

I think that is what we have been discussing here.

 

 

 

We, as doctors/licensed healthcare providers, are held accountable to both

 

 

 

LEGAL and professional (medical) ETHICAL dictates. Both have implications

 

 

 

with regards to disciplinary actions.

 

 

 

Because of this duality, we do not have the luxury of simply looking at the

 

 

 

LEGAL side of things while ignoring professional ETHICs to which we are also

 

 

 

bound.

 

 

 

It should perhaps be clarified that professional ethics are not the same as

 

 

 

personal ethics - the use of the phrase " professional ethics " is not subject

 

 

 

to personal ideologies of right and wrong. Professional medical ethics

 

 

 

describe a mode of conduct, among other aspects of medical practice, to

 

 

 

which we, as members of that profession, are held accountablWhether you

personally see it a different way, or personally think it should

 

 

 

not be so " black and white " and want it to be left up to the

 

 

 

practitioner. ..that's not really up to you. That's why we have a

 

 

 

professional code of ethics associated with the practice of medicine.

 

 

 

I understand you're trying to get paid for your work and that you feel

 

 

 

entitled to it...but I do feel that what you are asking puts you into both

 

 

 

professional ethical and legal grey-area. Personally, I would choose not to

 

 

 

tread into legal/prof. ethical grey-area by wanting to bill insurance for

 

 

 

services rendered to a family member, but that's just me.

 

 

 

However, it seems to me from your response, that the only way you will find

 

 

 

a satisfactory answer (so that you know for sure) is to hire a lawyer versed

 

 

 

in medical practice who will analyze both the legalities and professional

 

 

 

ethics and write an opinion as a result.

 

 

 

But, I seriously doubt that anyone on this list could possibly " know for

 

 

 

sure " (unless we have any JD's on here), myself included, because you are

 

 

 

not asking a very simple question. You are asking about something that

 

 

 

involves not just the complexities of the practice of medicine (professional

 

 

 

ethics, licensing boards, federal HIPAA) or the legalities of medial

 

 

 

practice (state laws/regs, which may vary) but also the legalities of

 

 

 

billing insurance (both state and federal laws/regs) and what does or does

 

 

 

not constitute insurance billing fraud. And then there will be individual

 

 

 

insurance companies to which each individual insurance company may or may

 

 

 

not have applied an explicit exclusion in their policies. Two examples that

 

 

 

come to mind:

 

 

 

Medicare (Section 2332) has an exclusion for treatment of family members and

 

 

 

will not reimburse physicians (a ref to that section is at

 

 

 

https://www. noridianmedicare .com/p-medb/ enroll/general/ services_

to_relatives. html)

 

 

 

and defines which relationships are part of this exclusion.

 

 

 

BCBS will not reimburse physicians for treatment of family members either.

 

 

 

There are likely others. Aetna, it appears, currently does not. However,

 

 

 

most insurance companies follow in the footsteps of Medicare w/ regards to

 

 

 

policy.

 

 

 

Long way back to my original point...which is why I have chosen to refer

 

 

 

back to our professional code of ethics which serve the purpose of keeping

 

 

 

our patients safe and keeping us out of trouble. And professional ethics

 

 

 

state that we should not treat family members unless it is an emergency or

 

 

 

short-term situation. (Even though, as Mike pointed out, that polling

 

 

 

results would seem to indicate that doctors do actually treat family members

 

 

 

despite the ethical dictates).

 

 

 

I also agree with Mike that it would be the insurance company that would be

 

 

 

most likely to file a complaint (as one would hope it wouldn't be your

 

 

 

husband;-) If the insurance company feels that you have wrongly billed and

 

 

 

accepted payment from them, they will respond. However, I have seen some

 

 

 

family battles get very ugly...sad.. .so it would make me extra cautious of

 

 

 

not-so-immediate family members...especiall y where children are concerned

 

 

 

where one of the two parents might not be so on-board...

 

 

 

As an aside, if you haven't read the HIPAA regulations on your own, really

 

 

 

worth doing since it is one of the legal regulations to which we are bound.

 

 

 

Great read for a Saturday morning...not!

 

 

 

Ug - well, I think I've run my point into the ground, for what it's worth;

 

 

 

so that's all from me on this.

 

 

 

Good luck.

 

 

 

J

 

 

 

____________ _________ _________ _________ ___

 

 

 

Joy Keller, LAc, Dipl.OM

 

 

 

Ramona Acupuncture & Integrative Medicine Clinic

 

 

 

Phone: (760) 654-1040 Fax: (760) 654-4019

 

 

 

www.RamonaAcupunctu re.com

 

 

 

 

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Posted
Posted

 Hi Richard and all:

 

--Richard-

Lots of money and hiring lawyers are not often the answer. The system  controls

the lawyers and more often than not they are not the most informed.... .I have

seen this to be very true needing to fire my lawyer(s) and take over my own

cases. Either they are ignorant or purposefully ignorant.

---

 

 While I did make that comment tongue in cheek, I fail to see how the teams and

teams of dedicated (as in " used for only one purpose " ) lawyers used by tobacco

firms, the AMA, etc etc do not weigh in very heavily in terms of inducing (or

impeding) change.

 Unfortunately, you are right that, because law is so varied and complex,

lawyers often find themselves very ignorant regarding what they are

representing. This is why organisations like the AMA don't hire lawyers on a

temporary basis, but rather dedicate a law firm to their cause. They end up

having the most knowledge of the territory, the loopholes, the most experience,

and of course they will win the battles they fight. All this, incidentally,

takes lots and lots of money.

 

 Lots and lots of money also serves to win propaganda battles. We have endless

examples of completely scientifically unsupported activities gaining scientific

credibility (in professional circles and in the general public) not through

proof or evidence, but through (simple and not even very imaginative) repetition

in the high traffic media. I hope I am not cynical here, but rather observing:

money talks.

 

 Money is a very flexible form of power, and as such, immensely effective. Money

is power, and in the Chinese Martial arts, power is second on a scale of three:

yut dam yi lik sam gung fu (1st, Courage; 2nd Power; lastly, Skill).

 

 Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

 

 

 

 

 

 

 

 

 

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