During one of my recent radio shows, a caller phoned in to say that he was hugely frustrated because an insurance company turned down the MRI prescribed by his doctor. The man was suffering from debilitating pain radiating down his leg, as well as numbness and he could not walk properly. The pain was so intense that he had to force himself out of bed in order to go see his doctor. Suspecting a herniated disc, the doctor prescribed an MRI but the insurance company turned down his request stating that he should try narcotic therapy first.
This man’s doctor was the best person qualified to determine his patient’s medical treatment not the insurance company. An insurance company is not supposed to prescribe treatment. I believe that if they do so and then the patient does not receive the treatment that the doctor prescribes and deleterious consequences ensue, it should be grounds for a malpractice suit against the insurance company.
The reason this story makes me so angry is that I see the same pattern in my practice on a nearly daily basis. The insurance companies are continually denying tests and treatment I prescribe and put the onus on me to prove the necessity of the course of action I deem best for my patient. It is outrageous to think that a bureaucrat without a medical degree who has not examined my patient nor has the experience and depth of knowledge needed to prescribe the appropriate treatment is placed in the position of determining what’s best for the patient. Worse yet, when I appeal and speak to a physician who works for the insurance company they may say I am correct but it does not comport with the guidelines of the insurance company and so they must deny the test or treatment. And this is not an isolated incident. It’s a battle that is being waged across all medical disciplines throughout the country. Physicians try to obtain the medications, tests and referrals that their patients need, while insurance companies focus only on cutting costs.
Importantly, in a new study recently released by the American Medical Association (AMA), 78 percent of the 2,400 physicians surveyed believed that insurers require preauthorization requirements for an unreasonable number of tests, procedures and drugs. Another study in the Western Journal of Medicine (2001) showed that a doctor seeing 22 patients a day, averaged one insurance hassle per every four or five patients. It was reported that over 40 percent of these hassles interfered with quality of care, the doctor-patient relationship, or both.
As we move ahead with healthcare reform, patients should know their rights, and lobby for the development of standards as determined by the medical specialty societies taking the decision-making out of the hands of the insurance companies, and acknowledge and respect the physician’s ability to prescribe the best course of treatment for a patient. Until then, patients will continue to suffer as did the fellow who called in to my show.