I go to my primary physician because she is a great doctor. Most of my doctor's charges are not covered by my health insurance. I choose to pay "out of network rates" to see her.
(I can't wait until I'm covered by Medicare and her bills will be at least partially paid by Medicare --but that's another issue for a different day).
Today's topic is the daily interference that my Doctor has to endure with Health Insurance Companies constantly undermining her health care orders and decisions.
In order to understand the situation fully, you should know that my physician, unlike many others, refuses any "perks" from drug company reps. She doesn't accept their gifts or their trips or their meals, or their event tickets. She severely limits the drug rep's visits, and isn't swayed by the drug company's marketing ploys.
My doctor won't prescribe a medication unless she has done her own independent research and believes that a particular medication is the best one for her patient.
In some instances she has prescribed generic drugs for me, and in others she has insisted upon prescribing a particular drug--usually based upon the results of a specific clinical trial conducted by a reputatble clinic or hospital that was conducted for patients of my same gender and age.
In short, my doctor does her homework and knows exactly why she chooses the particualr drug that she prescribes, and she doesn't prescribe it to curry favor with a drug company that is providing her with gifts.
Last month when I was in her office, she related to me that she had received 18 phone calls the previous day from various health insurance company employees, asking my doctor and her staff, if the doctor would countermand her orders and agree to prescribe a different drug instead. She related that this is standard operating procedure to attempt to save the insurance company money. She has to fight with them tooth and nail each and every time and considers it "a personal victory for her patients" every time that she prevails in one of these arguments with an insurance company.
Some times these insurance company battles require my doctor to get on a "peer conference call" with an insurance company paid doctor to argue her case for approval of a particular medication. Many times the "peer" physician that my doctor is arguing with has ablsolutely no training or experience in the particular medical specialty, or has no knowledge of the clinical trials of the drugs. In some cases, the "peer" has never even heard of the drug that she is arguing against the use of--yet the "approval" for the patient cannot be given until the "peer" says "ok." Explain to me the point of arguing the merits of the use of a drug that one of the parties has never heard of and knows nothing about. Could it be simply to frustrate my doctor into surrendering her principles?
Often times it is the same insurance company employee that calls back day after day knowing full well that my doctor always says NO, yet the calls continue, every day, in the same or higher volume, without fail.
I asked my doctor if the insurance company employees ever stop calling (because they know that my doctor never backs down). The answer is, they NEVER stop calling-- and they increase the peer calls whenever they can to make it more inconvenient and time-consuming to get an approval of something that should never have been questioned in the first place. It is that employee's job to continue to pressure our doctors, every day, in hopes that they will grow weary and give up the fight.
TALK ABOUT GETTING BETWEEN ME AND MY DOCTOR!!
I asked my doctor if her collegues face the same pressures from insurance companies that she does. She assured me that they all do, and that some of her fellow physicians have reluctantly admitted that they have grown weary of fighting the insurance companies day after day, and have acceded to their orders being changed.
My doctor also related that these problems never arise with her Medicare patients--only private health insurance company patients. Remember that the drug companies convinced the then Republican-controlled Congress and President Bush that they should include a provision in the Medicare Part D law that makes it illegal for the Federal government to negotiate with drug companies for lower priced drugs. So, the profit margins are already built into the cost of the insurance premiums for Medicare Part D and are built into the drug prices for Medicare patients.
This allows the insurance companies and drug companies to focus their energies solely on those of us who have private health insurance plans. Lucky us!
(Congress should fix the no negotiation provision of Medicare Part D as well, but that too, is a topic for another day.)
This madness has to end. We need a Single Payer system. We need to have Medicare for all, and those under 65 have to pay for it. Health insurance companies bring no value to the delivery of health care services and syphon off billions in profits that have nothing to do with keeping patients well.
Just think about the wasted energy and distractions that my doctor and your doctor face on a daily basis because of these oppressive, profit-induced insurance company practices.
Get mad about it and start expressing your outrage to your friends and neighbors. Write to your Member of Congress and Senators. Reach out and contact those in Congress from other states. Make them support REAL health care REFORM.
We have to demand better care and need to let our doctors do their jobs as they deem necessary, without interference and distractions.
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