Physician’s Weekly Editor-in-Chief, Linda Girgis, MD, recently co-hosted another installment of the #PWChat series, on how health insurance companies are harming patients, based on her recent blog post on the topic. Topics discussed included: whether or not insurance companies seem to be concerned with helping patients obtain the best care; actions taken or policies made by health insurance companies that are potentially harmful to patients; whether prior authorizations are good or bad, and much more!
Be sure to check back for the date/time for Part II of this #PWChat.
Below are the highlights from the chat. You can read the full transcript here, by scrolling down to the corresponding responses.
Click here for a look at our #PWChat schedule and recaps.
Question 1
Q1: Do health insurance companies seem to be concerned with helping patients obtain the best care?#PWChat pic.twitter.com/fYR8nYpfWx
— Physician’s Weekly (@physicianswkly) November 27, 2018
A1. Over the last several years, insurance companies seem less and less concerned about clinical outcomes and more and more concerned about profits. #PWchat https://t.co/tNH9m5xYqy
— Linda Girgis, MD (@DrLindaMD) November 27, 2018
A1: No. Insurance companies interfere w/ the Dr.-pt. relationship, obstruct care & deny care. They aren’t insurance companies anymore, but are “health plans” with big pockets, capable of influencing politicians to support their interests #PWChat
— Molly Rutherford, MD (@UnbridledMd) November 27, 2018
A1: Example: prior authorizations on meds pts have been taking for years. Why? No longer on formulary b/c backroom deals directly related to $$$ and profit, not in the best interest of the pt, whom “reviewer” of PA has never met. #PWChat
— Molly Rutherford, MD (@UnbridledMd) November 27, 2018
Question 2
Q2: What actions taken, or policies/decisions made, by health insurance companies are potentially harmful to patients, and how?#PWChat pic.twitter.com/dsGZ3zsF55
— Physician’s Weekly (@physicianswkly) November 27, 2018
A2. Many services require prior-authorizations that can take weeks. This delays patients getting diagnosed and treated. Diseases can be missed is the diagnostic tests are not approved. #PWchat https://t.co/a5jGO8zx90
— Linda Girgis, MD (@DrLindaMD) November 27, 2018
A2: prior authorizations on meds that pts have been stable on for years, sudden formulary changes leading to pts missing doses or paying more for meds. Thankfully, #DPC docs dispense at steep discounts as a workaround. #PWChat
— Molly Rutherford, MD (@UnbridledMd) November 27, 2018
A2: requiring a knee x ray before approving an MRI when ligament (not bony) injury is suspected (jumping through hoops)
— Molly Rutherford, MD (@UnbridledMd) November 27, 2018
A2: Recision and post-provision denial are probably the most visible toxic effects – people who accept a medical service expecting it to be covered, but then left with existential debt when the insurer denies payment or cancels the plan#pwchat
— Matthew Loxton (@mloxton) November 27, 2018
T2 Pushing patients to outpatients settings as a cost-saving option, fail-first medication policies, and step therapies (the worst), are all active policies of insurers that potentially harm patients and doctors. #PWChat
— ShereeseM, MS/MBA (@ShereesePubHlth) November 27, 2018
Question 3
Q3: Are prior authorizations a good or bad thing?#PWChat
I think we know the answer to this one, but let’s throw it out there anyway… Is there ANYTHING good about them? pic.twitter.com/wWnZoeCyev
— Physician’s Weekly (@physicianswkly) November 27, 2018
A3. Truly evil! They exist to reduce costs by denying needed medical care to patients. Decisions are often made by non-medically educated personel.#pwchat https://t.co/bF8Sg2sYgF
— Linda Girgis, MD (@DrLindaMD) November 27, 2018
A3: Some PAs for buprenorphine are several pages & even urgent requests take 72 hours, for an illness (opioid addiction) that is killing more people right now than MVAs. Definitely harmful, but who has liability if pt ODs and dies?
— Molly Rutherford, MD (@UnbridledMd) November 27, 2018
A3: There is nothing good about them from a doctor’s perspective. Is there any science to prove that they save the system money? Doubtful. #PWChat
— Molly Rutherford, MD (@UnbridledMd) November 27, 2018
Yes, there is evidence of benefit – Kaiser showed improvement in cost and quality by using integrated UM.
That is probably not typical in the industry though#PWChat
— Matthew Loxton (@mloxton) November 27, 2018
Question 4
Q4: Do health insurance company guidelines seem to be based on evidence-based medicine?#PWChat pic.twitter.com/mRmCLyxhLO
— Physician’s Weekly (@physicianswkly) November 27, 2018
A. Often, no. They may have been designed EBM but they lose that in actual practice. #PWchat https://t.co/Wr0AeWAgB0
— Linda Girgis, MD (@DrLindaMD) November 27, 2018
A4: Sometimes yes, but all to often NO (in orthopedic surgery). Some of their “guidelines” are internally written and absolutely wrong–> geared to DENYING payment and/or services. FOR CERTAIN! Frustrating & criminal #PWChat
— Nicholas DiNubile MD (@drnickUSA) November 27, 2018
Question 5
Q5: How important is it to keep patient costs down? Does keeping costs down seem to align with health insurance companies’ way of doing business?#PWChat pic.twitter.com/oR1D5urktV
— Physician’s Weekly (@physicianswkly) November 27, 2018
A5: 3rd party payment is THE reason for inflated costs. #DPC docs are demonstrating this daily. CBC billed through insurance >$100 CBC at DPC practice <$3 @AtlasMD how much money have #DPC docs saved pts on meds to date? #PWChat
— Molly Rutherford, MD (@UnbridledMd) November 27, 2018
A5: example: pt. w/ sharing ministry had a stent placed, got a bill for $150,000 & asked for “cash price” which was $30,000. Health sharing ministry paid 100% If he had “insurance” his 20% would have been $30,000 #PWChat
— Molly Rutherford, MD (@UnbridledMd) November 27, 2018
A5. With the escalating costs of healthcare, keeping costs down is very important. But, not by sacrificing patient outcomes. #PWchat https://t.co/AM2ixBNyEh
— Linda Girgis, MD (@DrLindaMD) November 27, 2018
A5 CRITICAL! The current rate of price increase is unsustainable, and will eventually eat the economy.
If we don’t bring it under control, we will return to an era where even small health issues derail the average person, and condemn them to a life of misery#pwchat
— Matthew Loxton (@mloxton) November 27, 2018
#pwchat pic.twitter.com/yAyB5eDWAG
— Matthew Loxton (@mloxton) November 27, 2018
