Statement on Insurance, Alcohol-Related Injuries, and Trauma Centers

The following statement was developed by the Subcommittee on Injury Prevention and Control of the Committee on Trauma and approved by the Board of Regents at its 2006 meeting. It was developed in order to assist trauma centers in identifying problem drinkers and in providing interventions for drinkers who are at risk to harm themselves and others. Brief interventions for problem drinkers have been shown to decrease recidivism among trauma patients, thus serving as an excellent prevention measure. However, although most trauma surgeons support such activity, in the majority of states, it is legal for an insurer to withhold payment to a treating physician or hospital if information demonstrates that the patient was intoxicated at the time of the injury. These states enacted their version of the Uniform Accident and Sickness Policy Provision Law in 1950.¹ In 2001, the National Association of Insurance Commissioners voted unanimously to correct this law in favor of providing payment for injured patients, irrespective of drug or alcohol involvement. However, such legislative change must be accomplished at the state level and, to date, only eight states have done so. This statement was developed to assist trauma surgeons and trauma centers in understanding this legislation and to encourage support for changes in insurance laws so that the hospital and treating physicians will not be penalized for providing an intervention that decreases the risk of future injury and death.

Alcohol is involved in some way in 30 percent to 50 percent of all traumatic injuries, and screening and interventions for problem drinkers have been shown to decrease recidivism at trauma centers.² In 1950, the insurance codes of 38 states incorporated the Uniform Accident and Sickness Policy Provision Law (Model 180, UPPL), which states that the insurer would not be liable for any loss sustained or contracted as a consequence of the insured’s being intoxicated or under the influence of any narcotic unless administered on the advice of a physician. Some insurance companies have invoked this law as a reason to discriminate against patients who are injured while intoxicated. More recently, the National Association of Insurance Commissioners voted unanimously for an amendment to Model 180 that states that this provision may not be used with respect to hospital, medical, or surgical coverage for an accident or sickness. However, adoption of this amendment requires approval at each state legislature.

The American College of Surgeons recognizes the following facts:

• 30 percent to 50 percent of injured patients have a positive blood alcohol concentration at the time of trauma center admission
• 83 percent of trauma surgeons believe that the trauma center is the appropriate place to provide interventions for injured patients who test positive for alcohol³
• Identifying patients with underlying substance use disorders provides trauma centers with an opportunity to perform interventions to motivate patients to accept treatment and counseling
• Alcohol interventions provided in trauma centers reduce the patient’s risk of reinjury by nearly 50 percent and are cost-effective, saving $4 for every $1 invested^4,5
• Many trauma centers and trauma surgeons are reluctant to measure alcohol levels in states where the UPPL is upheld⁶

In consideration of these facts, the National Association of Insurance Commissioners (NAIC) unanimously passed a new model law in 2001, which would prohibit insurers from denying coverage at trauma centers on the basis of patient intoxication. To date, eight states have adopted this model law.

Therefore, the American College of Surgeons strongly supports the new 2001 NAIC model law and encourages adoption of this legislation in all states. This action will enable trauma centers to fulfill their obligation to provide alcohol screening and interventions for problem drinkers as part of their program to prevent injuries and will ensure that access to needed care will not be denied on the basis of the UPPL.

References

1. NAIC Model Laws Regulations and Guidelines. National Association of Insurance Commissioners: Model Regulation Service. Kansas City, MO: Uniform Accident and Sickness Policy Provisions Law. 2004;II-180-1.
2. Soderstrom CA, Dischinger PC, Smith GS, et al. Psychoactive substance dependence among trauma center patients. JAMA. 1992;267:2756-2759.
3. Schermer CR, Gentilello LM, Hoyt DB, et al. National survey of trauma surgeons’ use of alcohol screening and brief intervention. J Trauma. 2003;55:849-855.
4. Gentilello LM, Rivara FP, Donovan DM, et al. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg. 1999;230:473-483.
5. Gentilello LM, Ebel BE, Wickizer TM, et al. Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg. 2005;241:541-550.
6. Gentilello LM, Samuels PN, Henningfiled JE, Santora PB. Alcohol screening and intervention in trauma centers: confidentiality concerns and legal considerations. J Trauma. 2005;59:1250-1254.

Reprinted from Bulletin of the American College of Surgeons
Vol.91, No. 9, September 2006