Sunday, July 29, 2007

Sick-o: MD vs. Insurance


I remember seeing a copy of the doctor's bill, circa 1957, when my friend was born. For a regular birth, no complications, her mother and sweet new baby daughter stayed in the hospital for 10 days. My mother had a c-section with me, and we were in the hospital for 14 days. Now I'm not going to go over how we could ever afford that in 2007, even WITH insurance (which is what, I believe Michael Moore's movie deals with), but what I find interesting is how the shift of medical power has gone from the physician to the insurance company.

I've worked in health care a long time. And I've seen important medical decisions being made by a person at ABC Health Insurance HMO,PPO,POS whose only acquaintance with biochemistry is knowing that green fuzz on bread means it's got to go.

When a doctor wants you to have a test, the first words out of your mouth are, in effect, I better check with my insurance company to see if I REALLY can have that test and WHERE I can have it. Some tests, whether Mr. M.D. deems them necessary or not, are stamped NOT MEDICALLY INDICATED. And some kid who's on summer break from college where he's an art history major has probably made that decision based on the playbook he's handed to make those judgments.

Don't get me wrong. The insurance companies have an appeal process. The doctor has to send in all kinds of documents and test results and the sequence of his thought processes that made him come to the decision that his patient needs an MRI or whatever. But that process can take a long frickin' time. It can sometimes be too long for some people -- who have passed the hope of possibly being cured, end up dying, with the family suing the doctor stating he "didn't act in a timely manner or in the best interests of his patient". Then personal injury attorneys and malpractice insurance attorneys have a go and tie up the doctor in depositions and trial for months. Because he's unavailable, and his partners are taking his patients along with their own, everyone is overworked, overstressed and THAT's a recipe for real life and death disaster.

I have worked with many, many doctors. 99% of them were honest, hardworking and truly trying to do what's best for their patients to the best of their ability. It's a real shame to see them spending so much of their time negotiating with insurance companies to provide the medicine or tests or care that their patients need. Without question, the patient should come first. Not the insurance company's bottom line.

Now, if you'll excuse me, me and my terrible cold are going to the doctor and hoping it will be covered by insurance.

2 comments:

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Nicholas said...

Go see Sicko. And try not to get too angry when you do.

The whole notion of a medical bill is an obscenity.