When interviewing for my book, I asked about insurance, but the topic came up even when I didn’t specifically ask about it. It was never positive in relation to practice.
A doctor said, “I expected to be around tough and hard cases. I expected it to be hard. I did not expect to have to think if the insurance company will not pay for it.”Another one said, “This completely changes the role we play as physicians The insurance companies are taking the ability to practice medicine the way we want to away from us.” Another doctor agreed, “It used to be in the days of yore you provide the services you thought were appropriate. Now there are restraints via insurance companies willing to pay what they are entitled to and what we can offer.” Another one agreed, “You have to watch the bottom line, or you get kicked off of the insurance panels and the hospitals and cannot earn a living. It is not most important to take care of people.” Overall, said one, “The insurance companies did not have as much power dictating things to me in the past as they do now.” One doctor said, “Insurance companies weren’t allowed to deem a recommended procedure as unnecessary not indicated and not reimbursable.”
The patients get hurt. “Patients don’t get adequate care sometimes.” and “They get inferior care,” said two interviewees. “Now almost anything we do we have to really think about the cost-benefit ratio to the patients. Will the insurance company pay? If not, can the patient afford it? Will the patient be physically harmed if they don’t get it? How can I help this patient?” Another said, “We see more patients skipping their appointments and meds.” Shockingly, “There are delays in diagnosis. Delays in treatment. And in some cases, I had to cancel surgery because of insurance reasons.” In summary, “We are not delivering as good a product as we think we are. It comes down to insurance companies having too much power over the processes.”
Insurance restricts medications and tests. “The insurance companies put pressure on you. They don’t want to approve tests,” said one doctor. In another example, “Insurance companies refuse to approve a drug that the patient has been on for years and is doing well.” Another doctor agreed, “You used to be able to write for any drug you wanted. Then a non preferred drug would cost the patient more this year they wouldn’t pay for it. Some insurance companies are telling me which generic to cover.” And a statement from another doctor, “I make occasional compromises on formularies.” Agreement from another doctor, “Now every single test that I order has to be put through an insurance company. I am talking to someone who gets paid $12 an hour who makes the decision.”
This all makes it hard to practice medicine, “The hoops we have to go through to get them what they need. The insurance companies won’t allow it even if they need it. Sometimes I can’t get an MRI for a patient even if it is what they need. Sometimes I have to settle for one medication when it might be okay when I know that the one that they really need would be better, but the insurance company won’t approve it.” Another doctor agreed, “Having to ask for permission for meds or a test affects my day to day operations and the ability to refer a patient.” Another doctor said, “With one patient now for example. I tried to keep him out of the hospital. But I needed more information. The test had to be pre-certified. It took three weeks. You cannot practice medicine like this.” And, “It does not permit me to provide the best possible care for the patients. The insurance company dictates what I can and cannot prescribe.” In summary, “Physicians are no longer able to advise what is best for the patients and do it. We now must advise and then wait for an untrained person in front of a computer to approve or disapprove and then waste a huge amount of time fighting them. A patient could be doing really well on medication, and the insurance company wants to switch them and then they do worse and then we have to appeal to get them back on what was working before. This is every day. I can’t give you what is best for you sometimes. I can only give you what hopefully your insurance company will pay for.”
Overall, there was no disagreement about the negative impact of insurance companies. “People are making decisions that they are not trained to make. They are not physicians”, as one doctor said.” Another said, “They have too much power to dictate what I can and cannot do. This is disproportionate to their mandate. Their job is to provide the funds. They have too much power. They use this mandate; their interest is profits and any way they can increase it they can do it.” If this next statement doesn’t terrify you, as the saying goes, you aren’t paying attention: “The insurance companies do not want patients to live. They make more money if the patients die.”
How have we allowed these behemoth, benefit denying, profit-making, insurance companies to hijack our health care system?
Peggy A. Rothbaum is a psychologist and can be reached at her self-titled site, Dr. Peggy Rothbaum. She is the author of I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship.
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