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Opinion: Letting insurers act as doctors is truly dangerous

On Behalf of | Nov 4, 2019 | Denied Insurance Claims

William E. Bennett Jr. has some strong views concerning insurers’ role in the treatment-approval process for patients, and he is not shy about communicating them.

Nor should he be. Bennett Jr. is a proven medical professional, being both a doctor and university professor of pediatrics. What he has to say about a deeply relevant insurer-linked issue in the health care community is notably important. We duly pass along the doctor’s key points to our readers across Oklahoma in today’s Mansell, Engel & Cole blog entry.

Here is Bennett Jr’s bottom line concerning insurers’ role in the “approve or deny” process concerning recommended patient care: It is misplaced and far too often yields egregious outcomes.

What especially draws ire from Bennett Jr. is the so-called “peer-to-peer” process pursuant to which he seeks to justify a select drug regimen or treatment for a patient after it has been initially denied by an insurer. The doctor laments that he is often forced to communicate with a party who is disinterested and far removed from a patient’s case and, moreover, wholly unqualified to weigh in on core details.

Additionally, the person on the other end of the phone works for a system that has a default policy of denial in the first instance regarding most patients. Bennett Jr. notes the stated rationale that insurers’ decisions spell cost-effective outcomes that more optimally benefit patients, but he calls out that nation as both bogus and harmful. He stresses that insurers’ decisions are “often not in line with medical opinion” and “reflexively deny medical care that has been determined necessary by a physician.”

Who is better qualified to make treatment decision, queries Bennett Jr., a trained doctor who interacts personally and closely with a patient or a far-removed bureaucratic who often lacks requisite knowledge?

We suspect that most of our readers are solidly aligned with the medical community when it comes to answering that question.