Friday, November 13, 2015

Insurance, bah humbug!

Prior approval, prior authorizations and peer to peer reviews are all tools by which insurance companies:
A.      waste provider time

B.      avoid paying for things providers think will benefit their patients
I will also point out that peer to peer is a misnomer. An OB/GYN is not a peer to a Genetics doctor. Just because you have MD after your name, you are not magically endowed with the knowledge and experience to judge the care of other disciplines of medicine. In the same way you would not want my favorite Gastroenterologist delivering babies, I don’t want you telling my doctors they don’t really need a microarray.
This is a world where a patient well managed on a non-narcotic pain medication is told it is better to be on Oxycodone, because it is cheaper. Forget the addiction potential- it is all about the bottom line.
Medicine is hard enough without adding these obstacles. How can we provide the best care when somebody wholly uninvolved gets the final say on key decisions?
Is this the best we can do?

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