Denied

You’ve been told surgery required to repair a herniated disc has been denied;  a mammogram to evaluate a new lump won’t be allowed; or you must be discharged from the hospital because an insurance company doctor you have never met will not approve further hospitalization.
 
As my patient’s advocate, I frequently must discuss their care with insurance doctors in peer-to-peer phone conversations.  This is what I do starting this conversation:  I get the doctor’s name; in what state they are licensed; their specialty; and tell them their name will be placed on the patient’s record as being a participant in medical decision-making.
 
With that, they must weigh their medical versus financial judgement, and know they might be subject to the same accountability I face.  Does this make a difference?  Sometimes.
 
Medical decision-making has been removed from your doctor and given to distant paper pushers of the insurance industry.  Urge your physician in their peer-to-peer conversations to make insurance doctors responsible too.  
 
Gene Uzawa Dorio, M.D.
 

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