Are insurance company doctors evil?

An article in the Sunday Boston Globe really bothered me. In “Hippocritical” Doctors, an OB attacked physicians who work for health plans. He was unhappy that they didn’t make the health plan pay for all the therapy he wanted for his daughter with cerebral palsy:

This doctor and others like him are making money denying care – and they might as well hang up their white coats. They may believe that their administrative decisions are medically justifiable. However, it often appears that they are hired because their MD degrees lend a patina of legitimacy to administrative decisions that are based on interpretation of a health plan’s policies, not a chart, lab test, or CT scan…

A physician who works for the health insurance industry told me that these doctors view themselves as having “an advocacy role for patient care.” Health plan physicians will argue that without them consumers would have no voice within the company’s walls. But I say let the businesspeople be the ones to withhold care in the name of cost savings and profit margins. Physicians are needed in the clinic and at the bedside, advocating for more care, not less.

The author shrugs off other physicians’ financial relationships with drug companies and banks, because they just damage society, “not… individual patients.”

I think the author is way off base. Remember the earlier days of managed care when doctors complained, sometimes legitimately about “being told how to practice medicine by someone from the HMO with a GED”? Isn’t it better to have a physician to speak with? Meanwhile, contrary to his statement, it doesn’t always make sense for the patient to get “more care.” It can be expensive and wasteful.

I sympathize with the author, who wants what’s best for his daughter, but health plan physicians don’t deserve the abuse he dishes out.

March 29, 2007

4 thoughts on “Are insurance company doctors evil?”

  1. I was an appeals nurse of an insurance company, and I hate to say it, but yeah, some of them are evil. They think it’s their job to deny everything that comes across their desk. There are appeal levels in place, but if you only get one level of appeal and you happen to get two of those doctors, you’re screwed.

    Not all are like that though, and some truly are patient advocates. And it goes that way for the UR nurses too. Some try to approve everything they can, others try not to approve anything. Even though all the nurses work from the same set of criteria, some interpret it differently. It’s a shame because in the end it’s usually the patient that suffers.

  2. I am one of those “evil” doctors. I understand the anger/frustration of not getting a therapy covered that you believe to be critical. I’ve experienced it myself with the company I work for. I do believe two key areas where this comes into play are:
    1) evidence-based medicine. Yes, everyone believes their case will be the 5% where the therapy actually works but the company is asked what’s the reasonable expectation (based on good research) that it will work.
    2) Benefit plan. Some therapies, while beneficial are not a covered benefit (home health aid for ADL assistance is a good example)

    When all is said and done I beleive firmly that cost is a core problem in our health care system. Physicians have to be a part of the system that looks at inidividual claims.

  3. This is sort of off the topic but interesting just the same. I am a Cat Scan Technologist in the Midwest. We compiled data showing that 95% of CT scans done from the ER were negative. Outpatients had a rate of 72% negative and inpatients had a 56% negative. Overuse Abuse?

  4. In response to 95% of CT scans being negative; one must also understand that the multitude of purposes that CT machines are utlized for. Couldn’t that data be skewed based upon reasonings that not every CT patient being scanned is there for a confirmed (Neg or Pos) prognastication…….maybe they just need to check internals….such as a car accident victim….careful with your unsupportive potentially misguided and inconclusisive figures you throw out there.

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