Recently an article in the New York Times dated January 25, 2010 caught my attention; the title – “Insurer Steps Up Fight to Control Health Care Cost”. With regard to this publication, I state as President Obama did in his healthcare speech late last year, “that this issue must be resolved before healthcare can be delivered with the primary objective of providing the best possible care available, directly to patients.”
Increasingly, in my office practice the single most pervasive and negative factor each day are the therapeutic restrictions imposed by insurance carriers. In my personal opinion, patients are entitled to the best care available for any particular problem. This should be the basic platform of quality healthcare, yet insurance carriers have become increasingly obstructive in allowing this process to take its course. If the proposed mode of treatment is not covered, permission to initiate treatment is invariably delayed. Consequently, the healing process is prolonged, is generally less effective, the condition may become chronic and the cost of care is substantially increased. Currently, my office requires one full-time secretary to assist patients in attempting to resolve these issues in order to permit the initiation of proper treatment.
For example – just 3 weeks ago, a patient presented on a Saturday morning having sustained a severe skiing injury to the right shoulder on the previous day. At the resort where this occurred, an X-ray had been taken and interpreted as being normal. The patient was provided with analgesics and a sling and was sent home. On the Saturday morning following the injury of the previous day, the patient presented at our clinic in acute distress. Over the next 3 weeks, 12 laser therapy sessions were administered. This resulted in complete resolution of the problem.
An orthopedic consult, requested initially, has still not reached the head of the waiting line. An MRI performed 2 weeks after treatment had been initiated, reported the presence of a Hill-Sachs fracture and extensive ligamentous and other soft tissue damage.
If the parents of this 15 year old boy had not been willing to short-circuit the system, institution of therapy would have been delayed, the course of treatment prolonged with undoubtedly a less than an optimal outcome. This is a clear-cut example where early treatment consistently applied and monitored can achieve an optimal result, devoid of any other considerations. It has still not been determined whether there is insurance coverage although both parents are high level professionals and are “supposedly” covered by several insurance policies. Incidentally, the patient has made a complete recovery, including a normal pain-free range of motion of the left shoulder, while the insurance battle rages on.
The hours of secretarial time wasted on paperwork and telephone calls required in order to stimulate carriers to honour their obligation is becoming increasingly complex and invasive. As we all know from personal experience insurance companies and their sales minions are happy to sell policies and collect premiums. Their glowing ads promise security, unlimited benefits and infiltrate the media at all levels. At the same time, the series of hurdles imposed on the way to compensation is becoming insurmountable. These imposed economics overshadow the need for both urgent and high quality care, which should be the primary concern. The result – an impasse in the delivery of healthcare, strangled by carriers primarily interested in profit margins. The ramifications of this state of affairs are negative from every perspective, particularly when an immediate and positive approach is so essential. No one appears to be pro-active in the struggle to correct these deficiencies, which play a major role in the breakdown of healthcare delivery systems. Before we can continue to move forward in a positive manner, this impediment must be removed.