“Health” Insurance companies have begun moving into the realm of delivering, or even more specifically - rationing, “healthcare” more and more over the past 10-20 years. Once upon a time, the doctor made the medical decisions for a patient - he or she knew the patient well, weighed risks and benefits, had a conversation with the patient and chose the best course of action. Today, the doctor’s role has been diminished in large part due to the interference of insurance companies.
If I want to order an MRI of my patient’s shoulder (of course following clinical guidelines on timing and indication) I cannot just send an order and have the patient get the MRI. Nowadays, I have to ask permission first. When I call the insurance company, I am usually sent to a “third party” - a company who handles prior authorization requests for that insurer. When I finally connect with a person (which often takes more than 30 minutes) I have to play a game of cat and mouse, answering questions in just the right way so that the non-medical-person on the other end checks off the right boxes that allows the automated system to determine whether my medical order for my patient is “approvable.”
Lauren Hedde, DO; James Hedde, DO and Mark Turshen, MD are Family Physicians and Co- Founders of Direct Doctors, Inc. a Direct Primary Care Practice.