“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 and Mark Turshen, MD are Family Physicians and Founders of Direct Doctors, Inc. a Direct Primary Care Practice.