One person's story about utilization management....BD

I am a registered nurse. Although I have spent most of my 25-year career caring for people, I made one enormous mistake. For a brief time, I chose to work for a medical insurance company. They gave me the title, "utilization review nurse," which really meant I had control over whether people were allowed procedures, stayed in the hospital or discharged early.

Because of my discomfort with a system that left me in charge of telling a doctor by phone, some 3,000 miles away with his patient, how to practice medicine, I was far more permissive with certifications than the company liked. My phone calls were soon tapped. I was denied bonuses and raises. Harangued and threatened, I was finally booted from the insurance industry.

I watched my own license abused by a medical corporation whose interest was not in saving lives, but in saving money, and whose profits soared as they denied claims under a "managed healthcare system." Meanwhile, its CEOs got salaries in the millions and stock values doubled.

Healthcare for profit bad : Opinion : Ventura County Star


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