Dr. David Scheiner, Barack Obama’s personal physician for twenty-two years (and an advocate of a single-payer system) was interviewed by CNN. He discussed ways in which insurance companies make it difficult for doctors:
You’ve said in interviews that insurers are making it increasingly difficult for doctors to do their jobs. Can you give some examples?
I’ll give you two. I have a patient with bipolar disorder whose psychiatrist is no longer in her insurance company’s panel. She is heartbroken that the insurance company won’t pay to let her see the doctor.
I have another patient with obvious sleep apnea. I ordered a sleep study on him. The insurance company knows he needs it but has made life miserable for him. They are making him wait to get their approval, hoping he won’t bother with it.
Insurance companies are making it more difficult for doctors to get preauthorization for treatments because they are hoping it will discourage people from getting expensive treatments.
Insurers also tell us what hospitals we can admit patients to and what subspecialists we can refer our patients to. They are telling me how to do my job.
As a doctor, how do you get around these challenges and ensure that your patient still gets the treatment they need?
Well, if you know that an insurance company is going to deny coverage, you word your request in such a way that will be more medically acceptable to them. I try to use certain buzz words that I think will help the patient get approval for a treatment. Insurers have no reason to question what I need for my patient, but they do.
Bureaucrats, in this case from the insurance companies, interfere with the decisions made by doctors and there are unnecessary delays in having tests and treatment. Many of the scare stories from the right are true, except the problem is often the insurance industry, not “socialized medicine” in their attempts to “ration” care to save money.
I have been covered with various policies for over 30 years, none which could be considered cream of the crop, yet I have never had any issue get anything covered. I know many people in the same boat. Granted there is bad cases but sink the ship because a few rats are on board? I dont think so!
If you’ve been talking about routine claims over 30 years then there is a good chance you might not have had a problem. It is also possible that if you developed cancer or something else expensive then they would drop you quickly. There is no way to know if it would happen to you, but this has become a widespread user–not a matter of a few bad cases. Insurance companies interfere with medical decisions to save money, and drop people’s coverage, far more than you realize. Nobody is talking about sinking the ship. We are talking about fixing the system to get rid of a tremendous number of rats.
‘Insurance companies interfere with medical decisions to save money, and drop people’s coverage, far more than you realize.’
Ron is one the money here, twistedmuser.
Insurance company interference with medical decisions is not always the overt and scary denial of treatment, either. Sometimes it is simply making something too much of a hassle to be worth the effort.
My partner has (among other things) asthma. Her doctors have always prescribed her two emergency inhalers a month, because she tends to need to use her inhaler a lot. This is not new, it is what her doctors have done since she first received her current insurance coverage at work. Before her insurance coverage, she got her two inhalers a month through a discount/free prescription program.
Periodically, for no reason, the insurance company decides to hassle her about her inhalers. They hold up the second inhaler and refuse to pay for it. When they do this, they tell her she is only allowed one inhaler a month and they will not cover the second. This is despite the fact that she has always been prescribed two and they have always covered it. So she is forced to jump through their hoops to get them to pay for her second inhaler. This takes time and energy that should not be necessary and inflicts extra stress.
It should be noted that they always end up paying for the second inhaler. They cover it, the doctors prescribe it, and they have no choice. Yet they consistently try again to make it enough of a hassle that she will simply give up and either not purchase it or pay for it in full herself. The most recent attempt to deny coverage for the second inhaler, the insurance company reps refused to speak to her pharmacist at all when she tried to call to explain the situation and receive clarification from the insurance company.
The reason they do this, as near as we can tell, is that they have kickback deals with the big pharmacies like CVS and Walgreen’s and they do not like that my partner uses a neighborhood pharmacy under local, private ownership. She does this because the service is superior to that of the big pharmacies in the area, the employees are more professional, and the pharmacists do more to get her the best price on her prescriptions.
The last, of course, does not sit well with her insurance company.
@BarackObama’s former doctor supports #singlepayer #healthcare. http://liberalvaluesblog.com/?p=10296 Medicare for All! #hcr #hc09 #p2
@BarackObama’s former doctor supports #singlepayer #healthcare. http://liberalvaluesblog.com/?p=10296 Medic.. http://bit.ly/Zw2uw
#p2
We just went thru this.
My wife fell down the stairs and shattered her left leg 10 months ago. After surgery, she needed training on how to use a wheelchair, walker, get up and down stairs and in-out of a car.
The insurance company denied paying this saying it was uneeded. The first cause was the wrong date (one day off) After we got that fixed, they said we ran out of time and had to appeal.
More and more hoops to jump thru. We got affidavids fro the hospital, surgeon, work orders from the surgeon, to the hospital, to the physical therapist,
They decided to pay today…i/4th of the claim to the hospital. Since the hospital takes BCBS, we shouldn’t be liable (per the insurance company letter and payment schedule).
This saga took 10 months to be rectified.
Along the way there were deliberate obfuscations by the insurance company:
miss-mailings, wrong documents, unsigned documents, wrong codes. My wife used to work in the managed care business as a software provider and she knows all the ins-and-outs of the insurance operations. Without this we wouldn’t have gotten this far.
@BarackObama’s former doctor supports #singlepayer #healthcare. http://liberalvaluesblog.com/?p=10296 Medicare for All! #hcr #hc09 #p2
@BarackObama’s former doctor supports #singlepayer #healthcare. http://liberalvaluesblog.com/?p=10296 Medic.. http://bit.ly/Zw2uw
#p2