Readers know of my hostility toward overdiagnosis and
overtreatment. I maintain that there is
probably twice enough money as needed to reform the health care system if
unnecessary medical care could be eliminated.
(Yes, I am including colonoscopies in this category!) The challenge, of course, is that one person’s
unnecessary medical care is another person’s income.
One institution that is routinely demonized are medical
insurance companies. They are described
as Houses of Greed who put profits ahead of patients by design. Every physician who is breathing can relate
tales of woe describing frustrating obstacles that insurance companies place
before us and our patients. When one of
my patients receives a ‘denial of service’ notification, I am always prepared
to discuss the patient’s case with a physician at the insurance company, as
this provides an opportunity for me to explain the nuances of the case to a
colleague.
Take the following quiz now.
Which of the following tasks is most difficult to
accomplish?
- Getting an upgrade from ‘coach’ into first class of the plane for free.
- Calling the IRS to get some personalized advice from a living, breathing human being.
- Understanding your medical bill.
- Solving your internet malfunction by consulting the company’s ‘FAQ’ page.
- Reaching the medical director of a medical insurance company.
Alexander Graham Bell's First Call to Insurance Co Doctor
'Sorry, Wrong Number.'
Yeah, I know I sound frustrated, and writing this blog post has
released some of the pressure. In fairness,
there are many times that the medical community and the public take advantage of the insurance companies. I will share
some thoughts on this in an upcoming post.
my experience has been a lot better. Dealing primarily with Medicaid, where denials are done by functionaries with algorithms, the real care takes place when the physician has to read the lab work and chart with you. The denial letters offer a phone number for peer to peer, and there are a few intermediaries who test your persistence, but eventually the doctor me back. I tell him or her what I would like to do and why but also ask the review what he might recommend instead that would be more cost effective and of acceptable efficacy. It doesn't take very long to convince them that I am a better decision maker than they are and we pretty much always agree to at least a short trial of what I want.
ReplyDeleteA lot depends on who you are treating. If the patient is basically sturdy and indestructible it is a lot easier for them to function as an impediment than if the patient is a diabetic with multiple sequelae who will be in the hospital with the next meltdown, or worse has already been in the icu. That they understand and will give the expert a blank check to avert the next crisis. Whether they do it for the patient or for the balance sheet, the right treatment decision is usually the same.
Hello Dr. Kirsch,
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