Sunday, June 24, 2018

Do Insurance Companies Care About Patients or Profits?

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.'

I know that these companies have medical personnel on the payroll, but finding them requires assistance from intelligence professionals.  They likely arrive at work in disguise and work in a secluded office behind a door labeled ‘Maintenance’.  Years ago, while I didn’t actually connect with a live physician, I was afforded the opportunity to leave my phone number on a voice mail.  If the physician did deign to return my call, it was never at a time that I was available to converse.  Since I do procedures every day, round at the hospital and have a few offices, the probability of the physician reaching me with a single call was equal to the chance that you will be served Surf ‘N’ Turf on your next airline flight.

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. 

If you need to call a doctor, take my advice.  Don’t call the one who works for your insurance company.  Try something when the odds will be more in your favor.  Play the lottery.


  1. 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.

    A 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.

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