A health insurer’s true motives

A patient came to see me with lower abdominal pain.  Was she interested in my medical opinion?  Not really.  She was advised to see me by her gynecologist who had advised that the patient undergo a hysterectomy.  Was this physician seeking my medical advice?  Not really.   Was this patient coming to see me as her day was boring and she was bored and needed an activity?  Not really. After the visit with me, was the patient planning to return for further discussion of her medical status?  Not really.

So, what was going on here.  What had occurred that day was the result of an insurance company practice that I had thought had been properly interred years ago.

The woman had pelvic pain and consulted with her gynecologist.  An ultrasound found a lesion within her uterus.  A hysterectomy was advised.  The insurance company directed that a second opinion be solicited.  A second gynecologist concurred with the first specialist.  The patient advised me that the insurance company wanted an opinion from a gastroenterologist that there was no gastrointestinal explanation for her pain.  In other words, they did not want to pay for a hysterectomy that they deemed to be unnecessary.

How should we respond?

  • We should applaud the insurance company for its diligence to protect the patient from an unneeded surgery.
  • We should recognize that the insurance company is focused only on promoting medical quality with no concern for saving the company money.
  • We should cite the insurance company for industry excellence for facilitating smooth and efficient medical care.
  • We should tell the obvious truth about what is actually going on here.

This woman’s treatment plan, as recommended by two gynecologists, was halted by a bureaucrat who likely had less medical training than they did.  I surmise that not enough boxes were checked on the submitted paperwork to permit the recommended surgery to proceed.   The insurance companies, of course, claim fidelity to a medical quality mission.  How would they like to be subjected to the same absurd level of scrutiny and oversight that they wield over us?  When the reform hammer comes down on the insurance companies,  my patient might be holding up a sign or a pitchfork, but it won’t be to stand up for them.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

Image credit: Shutterstock.com

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