"Dual Relationship" Doctrine in Group Health Plans of Health

[Christine Roberts]

Is anyone familiar with the "dual relationship" doctrine that discourages provision of certain types of health care (e.g., psychiatric/drug counseling) between co-workers, where the caregiver and the patient are both employed by the health care organization that sponsors the [ususally self-insured] group health arrangement??

[KIP KRAUS]

Christine:

I've never heard of it, but it makes sense to me. Why do you ask?

[Christine Roberts]

A client in the health field operates a self-funded plan and is inquiring as to how to handle requests by employees to see care providers who are also employed by the client -- evidently the dual rel'shp. doctrine is a byproduct of the psychiatric and drug dependency fields (i.e. for ethical reasons, co-workers should not also have physician/patient rel'shps.) The question then becomes, should this doctrine extend to less privacy-sensitive forms of treatment, such as dental care, acupuncture and the like? I believe the doctrine originally came from either (a) insurance law principles or industry protocol or (B) rules of professional responsibility in the medical/psychiatric field. Or a combination of both.

[KIP KRAUS]

Christine:

The most often restrictions I have seen related to this type of situation is denial of coverage if services are performed by a family member, or if services are performed by someone who would normally not charge for their services.

I’ve never seen that type of “dual relationship” exclusion in a group policy. However, as I said before it makes sense to me that you would want to discourage employees from getting involved with each other’s medical problems, especially psychiatric and drug and alcohol abuse. It may even become an ADA issue.