by Stewart B. Segal, MD
Every day of my life as a physician, two events are sure to occur. Event number one is that the sun will rise in the morning and set at night. Event number two is that I will receive a stream of insurance company denials of care from the time I open my door until the time I lock up at night. Insurance company denials are a fact of life. They are accepted by the public and fought by most doctor’s offices across the country. At great personal expense, I fight for my patients’ rights to proper treatment. I am amazed that my patients often do not fight for their own rights, capitulating to an ever more powerful and corrupt system.
I question my patient, listen to my patient, exam my patient and review an assortment of laboratory and diagnostic tests (if allowed by the insurance company) and then make a decision on proper care based on the needs of my uniquely individual patient. The insurance company reviews its finances, statistics and its interpretation of “evidence based” medicine and decides what the insurance company deems is “necessary”. The clerk who holds your life in his/her hands never sees you, the patient, nor speaks with you but, instead, pushes you into a square whole designed to fit the masses (an provide stellar profit margins). If you are a round peg or triangle, tough luck. The clerk is given rules based on “evidence based medicine” which is a tool the insurance companies created to justify its denial of your care. The insurance companies and their hired guns ignore the individual human factor that doctors have to deal with daily.
If all of this sounds bad, the following will sound worse. You, the patient and me, your doctor, can appeal for proper care. In order to win an appeal, we have to prove that you have failed on an inexpensive, generic treatment or that you are seriously ill and really,really need the test or medication your insurance company is denying.
Where else in society do we insist a person must fail before we allow them to succeed? What does failure mean? These are critical questions! Failure means you get sicker! Failure means you get side effects that were predictable! Failure means you end up in the hospital! Failure means you die! The risk of failure also means a smart person finds the money to buy the appropriate medicine (or have the appropriate test) and the insurance company wins. The insurance company gets to keep your money!
Why do we put up with this travesty? Are the insurance companies that powerful? The answer is yes; they are that powerful. So were the Congress and the Senate of the United States until the people of the United States had had enough. Whether you agree with their politics or not, the Tea Party should inspire all of us. It is time to take on the insurance industry. If all patients who receive a denial of care from any insurance company in this nation would stand up and demand their rights, as individuals, to the personalized and appropriate care their doctors render, things would change.
As it currently stands, insurance executives post ever increasing profits, are granted ever increasing salaries and bonuses, and each of us funds their greed and avarice. Its no wonder our health care system is in peril. The insurance industry pulls billions of dollars in profits out of the system every year. Those dollars do not care for a single patient, pay for a single test. Many of the dollars do end up in political war chests and fund the election of those politicians who continue to let your insurance company deny your care and raid your bank account.
Call your new senators and congressmen and women and demand an end of insurance tyranny. Demand that insurance companies be forced to live under the antitrust laws that govern the rest of us. Demand that the insurance industry be regulated and excessive profit taking be eliminated. Do anything other than except the constant whittling away of your right to good and proper medical care as defined by the partnership of you and your doctor.