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Is Health Insurance Compromising the Practice of Medicine?


One doctor seems to think so. Dr. William E. Bennett, Jr. is an associate professor of pediatrics at the Indiana University School of Medicine. Dr. Bennett just published an op-ed piece in the Washington Post airing his concerns over how insurance companies have influenced the overall practice of medicine. To put it bluntly, Dr. Bennett believes that insurance companies are making medical decisions for patients which create problems and delay treatments.

As a gastroenterologist, Bennett often prescribes expensive medications and tests for patients suffering from a wide array of ailments. He says that insurance companies won’t cover some of the treatments and tests he prescribes without a prior authorization from the doctor. This can take days or even weeks to clear up. In numerous cases, the insurance company will deny coverage. In that case, the doctor has the option of filing an appeal with the insurance company to have what is known as a peer-to-peer hearing. In other words, another doctor looks at the request and determines whether or not it is valid. Meanwhile, his patients are still suffering from their ailments and their conditions may be getting worse.

Denials are Almost Always Reversed 

According to Dr. Bennett, denials are almost always reversed after a peer-to-peer. He says that there is almost never a back-and-forth discussion and that he is hardly ever asked any questions concerning the treatment. So then why make patients (and their doctors) jump through all these hoops in order to get the treatment their doctor says they need?

While Dr. Bennett admits that the desired outcome (on a long enough timescale) is almost always the result of a peer-to-peer, he also says that the individual he speaks to on the phone, who is hired by the insurance company to screen insurance claims, almost never has the qualifications to render such an important decision.

Most patients, when faced with a prior authorization, will throw up their hands and figure it’s not worth pursuing. But this can be very dangerous. Even in cases where a doctor phones in a prior authorization, the doctor must be pressed into calling for an appeal. Even patients can call for an appeal. But most patients do not know how the system works and some doctors do not either. While this appeals process is grinding its way through the bureaucracy, patients are reportedly being denied treatments that their doctors say they need. Insurance companies seem to captilize on patients not knowing their rights and more often than not, it works the way they hoped. Patients tell the doctor that their insurance will not cover it, and the doctor is often too busy or unaware that they can file an appeal on their patient’s behalf.

Talk to a St. Petersburg Medical Malpractice Attorney 

If you’ve been the victim of medical negligence, the St. Petersburg medical malpractice attorney at Masterson & Hoag, P.A. can sue the negligent doctor and recover damages for your injuries. These include past and future medical expenses, lost time from work, and pain and suffering damages. Talk to us today for a free consultation.




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