When Insurers Play Doctor

One doctor's story about having to work with insurers to get the tests and procedures he feels due in one case here...this can end up being a huge amount of time spent not only by the physician, but also the staff as well...something the patient may not always see or be aware of...BD 

This doctor will go unnamed but is a practicing cardiologist.    “ Once my office received the call that the test was refused, I was again summoned for a “peer-to-peer” review.  In actuality, I’m certain that this is a cost-saving measure, and I doubt very much that Aetna or Medsolutions has any regard for patient safety or well-being.”

     “ Today I had a very disconcerting experience involving an insurance company. For the first time, I feel truly helpless at the hands of an insurance company.  My fears have come true: we physicians are quickly becoming pawns in the game of healthcare, with an ever decreasing capability to dictate appropriate care for our patients.”

The doctor says most of the time he/she and office colleagues have been successful in overturning the refusals.  But remember each phone call takes 15-30 minutes of productive office time that would be better spent with patients.  Today, the doctor says, “..despite my best efforts, I failed my patient.”

Because the test I ordered did not fit Aetna’s or Medsolution’s “protocol”, quite possibly created by businessmen without much medical background, my patient must suffer. I should not need to provide justification for preferring to perform one study over another as long as each is appropriately ordered.”

Unfortunately insurers pay the bills, so doctors have to pay attention. But that doesn’t mean they like it or agree with the type of health care they are sometimes forced to provide.  “ In conclusion, I and many physicians have trained for many years to make independent, clinically-directed decisions. Our practices are now being dictated by insurance companies with little or no medical education or experience. Due to anti-trust laws, we cannot band together to advocate for ourselves. Our medical lobbyists in Congress are outnumbered by the more financially-backed insurance companies. We need someone to step up and represent our voices and concerns to the people of our nation.”

When Insurers Play Doctor (Part 2)

Related Story:  http://www.phillyburbs.com/pb-dyn/news/292-08152007-1392802.html