Who Says Health Insurers Don’t Practice Medicine?
Posted on December 2, 2008
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When fighting a health insurer over a denial of benefits, it’s very tempting to complain that they’re practicing medicine by attempting to overrule doctors. Sadly, such behavior is interpreted by the folks in power as simple “management of benefits” or “determination of coverage”. However, as it’s described in this Sun-Sentinel article, doesn’t it seem like health insurers are coming pretty darned close to practicing medicine (and therefore should be exposed to medical malpractice claims)?:
A half-dozen insurers recently sent letters to tens of thousands of South Florida patients taking brand names, saying coverage will halt or co-payments will increase Jan. 1. The companies suggest people ask their doctors about changing to cheaper drugs to save up to 80 percent.
But some doctors and pharmacists say switching drugs to save money — in some cases several times a year — could expose patients to health complications and drugs that don’t work well for them.
“It’s not a matter of getting you, the patient, the best medication. It’s a matter of [insurers'] not having to pay as much for it,” said Miami neurologist Bruce S. Rubin, who heads a Florida group opposing such substitutions. “I choose one drug that I think will be best, and I don’t want [an insurer] second-guessing me.”
Tags: Drug Benefits
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