Insurance Company DENIALS (What you NEED TO KNOW about them!)
There is nothing more maddening for a practicing physician than hearing that something he or she ordered was denied by an insurance company.
Sometimes it's a lab test, sometimes an imaging study, or in certain cases a referral to a specialist. Although such denials are based on protocols and certain guidelines, most of the time these denials are just a simple act of stonewalling from insurance companies. Why?
Well, it saves them a ton of money.
But here's the most interesting part that nobody ever talks about: All health insurance companies boast the fact that "their" doctors are good, kind, and caring. They list their contracted physicians online and send out nice brochures listing their hand-picked selection of doctors. They claim that their doctors were chosen over other doctors is because their doctors are experts who know what they are talking about when it comes to treating patients, whose opinions, recommendations, and advice can be trusted with the most important thing we have, our health.
Yet, they routinely deny their doctors, their special chosen doctors, the right to do what they think is best for a patient, such as by rejecting certain requests from doctors all because they don't want to cover them.
Doesn't that seem a bit contradictory? Yes, it certainly is. Yet, no one ever asks how this is alright.
The insurance companies contract doctors for their expertise yet they feel free to ignore that expertise whenever it's more profitable.
There has to be some sort of notion and understanding that MOST doctors are guided by altruistic motives and truly want to help patients and deciding what labs, imaging studies, referrals, etc... to order should be up to PHYSICIAN, not a faceless insurance company that does not have the expertise that it's contracted doctors do.
But unfortunately, there is very little transparency when it comes to what physicians are actually allowed to do by the insurance companies, which is why most doctors can understand the frustration of being denied a request by an insurance company for reasons that are unclear.
They feed us rhetoric that if doctors are allowed to order "what they want" then healthcare costs will skyrocket. But there really is no solid evidence of that. Most doctors don't want to run up a patient's or an insurance companies bill, they just want to do everything they can to treat the patient. But tests are expensive and insurance companies are willing to go great lengths in order not to cover them.
We should not accept this as a norm any longer. Doctors and patients alike must be more vocal about these matters: about how insurance companies pick out doctors for patients but don't even listen to them.
How long are we all going to remain at the mercy of these health insurance companies?
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