Blog | Monday, June 20, 2016

Medical insurance companies: heroes or villains?


Physicians are expected to be hostile to insurance companies. Indeed, a prior Whistleblower post directed arrows in their direction. They are an easy target, often vilified for their greed and perceived indifference toward those they insure. Ask most of us if we think insurance companies favor profits over patients, and most of us will respond that profits prevail.

Insurance companies are businesses, not charitable undertakings. Sure, we all like free stuff. Or, if it's not free, we prefer that someone else pays for it. We are outraged at the costs of chemotherapy, hepatitis C treatment and biologic treatments such as Humira and Remicade, leaving aside the zillions of dollars it takes to research, develop, manufacture, market and monitor innovative new drugs.

We want to drive a Cadillac, but only pay for a Chevy.

No person, business or organization is wrong all of the time. Consider the following practices. Who's side are you on here?

A patient has chronic back pain and ran out of his pain medications on the weekend. He calls the doctor and is connected to a weekend covering physician, who declines to refill the medicine. The patient then proceeds to an emergency room, where he is evaluated and given the desired prescription. Who should pay for the ER care?

A patient is seen in the office and prescribed a 2-week course of antibiotics for diverticulitis. The medicine nauseates him and he stops them in 3 days. He does not contact his physician. Ten days later, he develops severe abdominal pain and fever and needs to be hospitalized for severe diverticulitis. He is in the hospital for 5 days and is seen by numerous medical specialists. Who should pay the costs of this hospitalization?

A 55-year-old individual has never had a colonoscopy performed. His primary care physician advises him to proceed, but the patient declines. A decade later he is discovered to have colon cancer and needs to be hospitalized for surgery and evaluation by an oncologist. Who should pay for the costs of his care?

If a patient with high blood pressure, skips appointments and his medications, and a complication develops …

I'm not carrying water for the insurance companies. I am pointing out, however, that we often expect them to pay for medical care that is either inappropriate or should not have been necessary. That's not reasonable or fair. Don't we have a responsibility to be personally responsible?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.