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Wednesday, November 6, 2019

Insurance companies aren’t doctors. So why do we keep letting them practice medicine?

(iStock) (Minerva Studio/iStock)William E. Bennett Jr.
The Washington Post
Originally posted October 22, 2019

Here are two excerpts:

Here’s the thing: After a few minutes of pleasant chat with a doctor or pharmacist working for the insurance company, they almost always approve coverage and give me an approval number. There’s almost never a back-and-forth discussion; it’s just me saying a few key words to make sure the denial is reversed.

Because it ends up with the desired outcome, you might think this is reasonable. It’s not. On most occasions the “peer” reviewer is unqualified to make an assessment about the specific services.

They usually have minimal or incorrect information about the patient.

Not one has examined or spoken with the patient, as I have.

None of them have a long-term relationship with the patient and family, as I have.

The insurance company will say this system makes sure patients get the right medications. It doesn’t. It exists so that many patients will fail to get the medications they need.


This is a system that saves insurance companies money by reflexively denying medical care that has been determined necessary by a physician.

And it should come as no surprise that denials have a disproportionate effect on vulnerable patient populations, such as sexual-minority youths and cancer patients.

We can do better. If physicians order too many expensive tests or drugs, there are better ways to improve their performance and practice, such as quality-improvement initiatives through electronic medical records.

When an insurance company reflexively denies care and then makes it difficult to appeal that denial, it is making health-care decisions for patients.

The info is here.