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.