Fan Forum - View Single Post

ceilirose · 06-26-2008, 07:25 PM

Medical care's state of denial

This link is to a story about cancer patients in California and the battles they have when their doctors order tests which their insurance companies then don't approve. It's a long one so I'm only showing some of it.

My question is - do other countries that have universal health care run into these same issues?

Quote:

06-22) 17:38 PDT -- Doctors are supposed to prescribe tests and treatments that are medically necessary for their patients. Health insurers are expected to cover that care, while keeping inappropriate expenses in check.

But what happens when that process breaks down and sick patients are left to fight for medical care?

Each year, thousands of Californians find themselves at odds with their health insurers over whether they, as patients, should get the treatment their doctors prescribed.

Peter Isgro of Santa Cruz is among them. His insurer, Anthem Blue Cross, stopped paying for certain chemotherapy drugs after his cancer progressed, a decision that has been upheld in two appeals.

Isgro said he feels like the insurance company is second-guessing his doctor. "If your doctor wants to give you something and they can deny it, that's wrong," he said.

Anthem Blue Cross said it follows strict protocols, relying on medical evidence in determining what is necessary and appropriate to cover.

"Even in a dire situation, it is ethically appropriate to withhold treatment if it's not effective," said Dr. Michael Belman, medical director of Anthem Blue Cross, who was not speaking specifically about Isgro's case. Belman said doctors do not always recommend the best treatments, and cost is never a primary consideration.

Consumer advocates, however, see the situation differently.

Health insurers "are going back to the old strategies of the '90s, when they interrupted care on the front end by denying or delaying treatment offered by a doctor," said Jerry Flanagan, health advocate for Consumer Watchdog, a Santa Monica group. According to him, insurers hope patients will give up or settle for less, either way saving them money, a contention the companies dispute.