Just weeks after insisting they had no "gag rules" that limited what doctors can tell patients, two Kansas City health-care companies said Thursday they would eliminate contract language that some doctors said imposed such limits.

The action by HealthNet and Blue Cross and Blue Shield of Kansas City comes amid a national debate over whether some managed health-care groups limit a doctor's right to tell patients about treatment options and other health-care information.Critics, including the American Medical Association, say managed-care companies sometimes don't want doctors to tell patients about possible treatments, especially expensive treatments, that the companies don't cover or don't want to pay for.

For example, critics contend, such rules might prevent a doctor from telling a cancer patient about a bone-marrow transplant that might save her life.

"Gag rules endanger patients' lives by preventing them from knowing when they are not getting the right information," said Richard Hellman, a physician who heads the national government affairs committee of the Metropolitan Medical Society of Greater Kansas City.

The clause that HealthNet is eliminating states:

"Physician agrees not to disparage plan or its processes, programs or policies to any persons, including members or other participating providers. Disparagement of plan will be treated as an administrative compliance failure."

HealthNet says this "disparagement clause" merely protects it from slander, though officials acknowledged Thursday that the clause could be misinterpreted to constitute a gag rule.

Doctors said the clause could prevent them from pointing out to a patient that he or she could be better treated for their illness at a competing plan, thus "disparaging" the plan the patient is in.

Blue Cross on Thursday said it, too, was eliminating contract language that "could be interpreted as a `gag' clause."

The issue gained prominence with a January Time magazine cover featuring a doctor with a gag in his mouth. The debate has led to anti-gag rule proposals in Congress and several states.

In Kansas City, HealthNet public affairs director Cheryl Dillard addressed the issue in a Feb. 14 guest article in The Kansas City Star. Dillard was responding to a Feb. 3 column by Stephen Winn, deputy editorial page editor, who wrote that gag clauses existed at many health-maintenance organizations.

"Nothing could be further from the truth here in Kansas City," Dillard wrote. "None of the health plans signing below or other large, well-established plans in Kansas City have contracts that prohibit physicians from discussing with patients medical conditions or treatment options available inside or outside the network.

"Just the opposite is the case. Managed-care plans stress a comprehensive, preventive approach to health care - not an approach based on limiting service."

Dillard's article was said to represent the views of HealthNet, Principal Health Care, Humana Health Care Plans and Blue Cross and Blue Shield of Kansas City.

In January, the Metropolitan Medical Society asked its member physicians to notify the society of any gag rules in Kansas City.

Hellman said relatively few doctors responded, which he speculated was partly due to fear of insurance company retaliation. In addition, he said, some doctors probably weren't aware of what was in their contracts.