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Denial of Services by Medical Insurance Companies
Keywords:
Insurance
Started by
Radiol11027
Posted On
Category
General Patient Interest
Comments
10

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A frustrating element of patient care is when a physician orders a test or sevice and the patient's insurance company denies patient coverage.  This poses several problems including  the trust of the patient for his or her physicain. Who is to be trusted,  the insurance company or the ordering physician?  Another problem is delay of diagnosis.  Denial of a diagnostic test may lead to delay of diagnosis.  Should insurance companies be held accountable in the  same manner that physicians are held accountable for "delay of diagnosis"?  Does the insured patient have  legal recourse? In my opinion denying medical services by countermanding a physician's order without examining the patient constitutes practicing medicine without a license or at least medical malpractice.

 

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Surg90607

I am not sure what is the right answer. Dealing with insurance companies for pre-certs is certainly painful and frustrating experience in general. Arguing with insurance company "peer" physician takes the cake. Ahhhh!!!!!!!

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Gastro97262

That is unfortunately the new reality

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Peggy99748

I think it would be difficult to practice medicine if someone from insurance company will keep second-guessing you and deny tests, treatments and/or surgery.

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AlIMed64297

I think the insurance companies have to do it to control expenses- otherwise the physicians will keep on doing expensive tests even when these tests provide little or no meaningful information for solving/treating a patient's problem.

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CTVS10483

I agree that part of the reason why insurance companies have to refuse certain tests is to control 'overuse' of tests, procedures and surgeries by certain doctors. However, the insurance companies now overdo this and routinely deny tests/procedures that are genuinely indicated and thereby compromise the quality of patient care and often result in sub-optimal patient outcomes.

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Smith20295

I think that the insurance companies and their "hired" physicians who deny services without having seen the patients should be held accountable if patients suffer because of the denial.

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OncSurg51524

It irritates me no end that someone who has never seen the patient and is not responsible for the treatment outcome will just tell me that I cannot do this test or I cannot prescribe this treatment (technically I can prescribe but they will not pay for it). These morons (the company physicians) that we talk to in peer to peer "discussions" are not willing to see reason and have pretty much made up their mind even before the discussion and most of them don't even understand what we are trying to do.

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Gastro97262

I fully agree that it is ridiculous for the insurance companies to be denying a test which has been ordered by the treating physician. I know a doctor who is on the panel of an insurance company for peer to peer discussions with treating physician regarding the need for a particular test/surgery. He was told that his target was to deny about 30% of the tests ordered and brought to his notice. The peer to peer discussion with insurance company doctors is a joke- they have usually made up their mind before the conversation starts. They have never seen the ...

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Ernst02981

Being in finance, I understand why the insurance companies do what they have to do to increase their profits. But in healthcare it just does not seem right- the families of patients are already under a lot of duress and for them to go through the torture of dealing with insurance companies to get each procedure approved and then deny procedures and tests arbitrarily is just wrong.

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Gastro97262

I couldn't agree more

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