Mansell, Engel & Cole

An obvious source of frustration for patients and their doctors

A chief policy maker at national health insurer Blue Cross says that it is precisely because her company "really, truly" cares about what is best for its policyholders' health that it often denies MD-suggested care treatments and tests.

A patient featured in a national report on insurance denials counters that such a claim is sometimes bogus and smacks more of mere paternalism.

"I felt bullied," he noted in the above-cited media spotlighting of the thumbs-down response that insurers often give when doctors recommend treatment that requires prior authorization. The patient was turned down for a pelvic MRI and noted that his denial was "almost like a parent telling a child, 'because I say so.'"

Moreover, that individual's frustration and confusion were compounded by this insurer-driven injection of uncertainty: Blue Cross coupled its MRI denial with acceptance of the same procedure from another medical provider in the same city. The above article notes that, when questioned about that inconsistency, the company "could not speak to why the MRI was approved through one doctor but not the other."

The engendered confusion -- yes at one clinic, no at another, with no offered explanation to clear up the difference -- left the would-be MRI recipient flummoxed but not speechless.

"There's something flawed here," he told reporters.

Ultimately, and because he was in constant pain, the individual opted to undergo the procedure at the clinic he was most comfortable with.

Sadly, that turned out to be the facility where Blue Cross had denied authorization for the MRI. The bottom line was a $2,340 sticker price, which the patient paid from his own pocket.

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