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Post by Admin on Dec 10, 2019 17:33:33 GMT -4
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Post by Nick Schuck on Dec 10, 2019 18:28:17 GMT -4
Insurance is a large problem in health care. The article makes very important claims about how insurance companies are making the final decisions about how a patient is cared for irregardless of the fact that they have not spent any time assessing the patient's symptoms. They make all their decisions based on a take list of we accept this, cause it's probably cheap, but deny over half of treatment options possible it seems. It is one of the points where we all have to consider universal healthcare, as much as this has probably been talked about. I will focus on what we currently have though. I would find it interesting to know how many appeals really occur, and of those that don't appeal is it due to the patient not knowing or also the possibiity that it also adds more tasks to the physician's day, reducing the overall care he can provide to his patients.
The reality about insurance is that it has become essential since medications and treatments have become so expensive that 95% of the population can't afford them on their own paycheck. They need the insurance companies to help incur the costs and this demand then puts the insurance companies in control. They have more power and can make decisions based on how it affects their bottom line, not on the basis of which treatments are proven to be more effective.
The next question we would have to ask ourselves is as physicians we do want a change, but how can we make that happen? Insurance companies and pharmaceutical companies have both the time and the money to lobby to make sure that their systems stay in place and change only when it is more beneficial to them. We can't go on strike cause it harms the patients more than the companies. The best we can do is hope for change and consistently try and call out the insurance companies for their wrongdoings and do what we can to fight for our patients to get the treatment they deserve.
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Post by NS on Dec 10, 2019 22:48:28 GMT -4
Where do we start? This has been and will continue to be an issue in healthcare unless the powers that be change it!! Everything boils down to government regulation. Unfortunately, with that kind of control, insurance companies have the power to deny access to medications that could be more beneficial for the patient. For instance, just today I saw a workers comp patient who has excruciating back pain rating 8/10 with the use of drugs. One of the medications came in an extended release form, but Dr Antin could not order the drug due to the high price of $43.00/pill, when the other med that she was already on was priced at $1.00/pill. He mentioned that the ER medication was most likely better, but insurance would not pay for it because of the high price. He actually wanted to order the drug for the patient, but his hands were tied. It was extremely disturbing, as this patient is not really getting her needs met in regards to pain management. It just seems like as long as insurance companies are approving something for the patient, it's not considered "neglect of care." In the end the patient is typically the one who suffers the most because even if the medication regimen isn't a great plan of care, the insurance companies are still making a ton of money no matter what. How do we change the culture? Perhaps more lobbying for: more preventative medicine to minimize chronic disease, universal health for all, or more stringent price caps on drugs that are the most beneficial for disease management. Honestly, I'm unsure how to change this problem here in the US. Unfortunately, we live in such a capitalistic society and it's sad to say this but if it's not making money then it's not right.
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Post by JH Guest on Dec 10, 2019 23:45:55 GMT -4
For one who has pursued a career in medicine in hopes to keep the focus on the best interests of patients, I definitely feel that Insurance companies seem to be at the opposite end of the spectrum in regards to this goal. Although I must admit that I am somewhat naive to all the facets of medicine that Insurance companies are involved in, I have gathered that they seem to always assume the role of a bully, determining how well or complete a service that a sick or ill patient can receive. Based on what I gathered from the article, it seems that at the root of the problem with Insurance companies and there control of the practice of medicine is a disconnect between them and the actual patient who pays them for their coverage. Physicians that actually treat the patient often run into walls with the insurance companies, making it more difficult to appropriately care for the patient and their best interest. It seems that the process of making appeals to insurance companies takes much longer than a reasonable amount of time needed for the patient's management to be adjusted. I found it interesting that the article shed light on the fact that about 1/3rd of all insurer denials are overturned, leading one to believe that the initial decision to deny coverage for a particular procedure or medication was left to a person's "judgement/preference" which often seems to not concur with medical opinion. In conclusion, it seems that the priority of insurance companies is solely focused on saving insurance companies money. Medicine, like all other entities is a business so it the concept of saving money is understandable, but this should not supercede the effective management of patient's who are clinically and diagnostically proven to need specific intensive care. Insurance companies, whether they acknowledge this or not, are truly intervening in the decision-making process that should be the shared responsibility of the physician and patient.
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Post by KM on Dec 11, 2019 4:59:03 GMT -4
As an individual who has been on the brunt of insurance company's wrath before, this sets me off. Insurance companies, although a very great medium in the financial realm, tend to dip way too far into the treatment and mitigation of symptom realm for my liking. I personally suffer from hyperhydrosis and had to wait nearly two years before any effective treatment could be prescribed to me. I had to prove that each treatment was ineffective although about halfway through them, my dermatologist stated the solution would be Botox because of my presentation. I had to prove to insurance that the Botox injections was medically beneficial and not being utilized for cosmetic reasons. That floored me. Who receives cosmetic arm pit injections except maybe arm pit models? I understand medications factor in at differing values, but it doesn't make their price gauging and manipulative tactics any less annoying. I believe if a pysician knows the best treatment of choice or generalized screening needed is easily determined but may be the third in the chain of events for coverage is determined to be definitive in this situation, I believe they should be able to do it no questions asked. With this comes more strict limitations on the
reasonings for order and maybe even the burden of proof on a physician, but I believe it may possibly limit the amount of damage done through negligence and overall wasted time.
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Post by LP on Dec 11, 2019 10:58:09 GMT -4
This article brings a very important aspect of medicine to light. I really could appreciate the part of the article that states that many insurance companies “reflexively” deny patient claims. I think has been felt by almost every single patient that has insurance at one point or another. I can appreciate the fact that physicians are trying to fix part of the issue by doing peer-to-peer conversations to help remedy the situation, but it isn’t enough. In my opinion, patients shouldn’t NEED a physician to go to bat for them in order to get coverage for a condition. And they especially shouldn’t have to defend the claim to someone who sits behind a desk, has no idea of the patient or the condition. In addition, physicians should be able to provide care, not be on the phone explaining a patient’s case or playing phone tag with someone for precious minutes out of their workday when they could be with patients. This not only prolongs their workday, but can take time away from their home-life balance if they’re having to take these things home with them. At the end of the day, patients get insurance to protect themselves for outrages costs of procedures and visits and pay monthly or yearly ALREADY to have the insurance. So, having that insurance company routinely “reflexively” deny claims, is not right.
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Post by SW guest on Dec 11, 2019 12:58:05 GMT -4
This article is very interesting regarding to procedure of prior approval of efficacious medications. As licensed professionals, deciding to provide the best medical option to patients should be reserved for expertise and training of the medical provider. Requesting medications through the roller coaster ride of prior approval is time consuming and delays much needed medication that patient may need. In looking back to other countries that manage healthcare, Great Britain Canada and Germany are void these issue because of how the system is structured, lack insurance regulation of healthcare. In addressing the modification of our currently healthcare system, I think the interest holder and stakeholders should be addressed regarding the prior approval process. I think minimizing the integration of insurance company into healthcare is an effort the medical professions in general to change the need or use insurance companies.
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Post by GS on Dec 13, 2019 19:23:04 GMT -4
Insurances require prior authorization as a cost control method for their insurance company. However requiring prior authorization before a physician can prescribe medication, perform a test or provide therapy can result in a barrier to care and causes unnecessary harm to the patient and the patients family. As the article states insurance companies are practicing medicine without accepting professional, personal or legal liability. Just the other day a patient came to the office requesting an Invega injection however insurance only covered their Invega pills. Furthermore as per the Washington Post article insurance companies are even denying claims from the Emergency room. There was another article by VOX regarding patient Brittany Cloyd a 27 year old female who came to the ED in Kentucky with RLQ pain. The doctors suspected appendicitis order CT scan and ultrasound but discovered she had ovarian cysts instead. A few weeks later she received a hospital bill of $12,596 because the health insurance company deemed her emergency room visit inappropriate. It seems in this particular situation the insurance company expected a lay person to know their own diagnosis and discern if it required and urgent care visit or an emergency room visit without a medical degree a CT scan or an ultrasound which is just not practical. There should be more oversight into the practices of private medical insurance companies.
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