Docs call this the worst part of practicing medicine—can you relate?
Industry Buzz
We are no longer the decision maker for patients. No matter what I want to do, there are insurance companies that won’t let you do what you want to do.
—Betsy Grunch, MD
It's disheartening as a physician to know that what I deem medically necessary and in a patient's best interest is often disregarded based on complex insurance algorithms that are in place to ensure maximum profits to corporations.
—Tonie Reincke, MD
There are many reasons people choose to pursue a career in medicine. They want to help people, love science, or want a job that’ll always provide opportunities to learn, to name a few. And while caring for patients can be incredibly rewarding, the job comes with its own set of challenges.
One neurosurgeon, Besty Grunch, MD, recently shared on Instagram what she believes to be the most difficult part of the job—and it's something many of us can likely agree on: navigating health insurance policies and working through legal red tape that influences the procedures she can and can’t do.
“We are no longer the decision maker for patients,” Dr. Grunch said. “No matter what I want to do, there are insurance companies that won’t let you do what you want to do.”
MDLinx surveyed a few doctors about their thoughts on the matter—here’s what they had to say.
Related: Doctors speak up: The most common patient health insurance challengesA psych perspective
Cooper Stone, DO, a psychiatrist based in Philadelphia, PA, says he whole-heartededly agrees with Dr. Grunch’s take.
“It can be very demoralizing for anyone, having invested many years of our lives into studying medicine and just wanting to help people, only to find ourselves confronted with nebulous time-consuming roadblocks and barriers put in place by insurance companies,” he tells MDLinx.
He says physicians work hard to earn their medical licenses and it’s frustrating to see health insurance companies call the shots without having seen or evaluated the patient. Many psychiatrists have chosen not to be in-network with insurance companies, instead opting to be out-of-network or private-pay only, according to Dr. Stone.
“This way they can build as much separation as possible from having to deal with insurance,” he says.
An oncology perspective
This take also resonates with Guy Jones, MD, medical director of oncology Nevada and Sermo Medical Advisory Board member.
“A patient's insurance is the gatekeeper for all tests and treatments, and insurance is 100% focused on the bottom line,” he tells MDLinx.
He tries not to let insurers impact his recommendations to patients, but it does occasionally limit what he can offer. The most common issue he sees is that insurers prohibit a test or procedure because it’s not included in the patient’s insurance plan—as if the patient knew they would need certain treatments before they enrolled in the plan.
Unfortunately, oncology coverage has worsened with Medicare Advantage plans, he says. He’s constantly told that Medicare Advantage won’t cover treatments that Medicare covers. “It's a game, and insurance companies play it well,” he says.
Related: Docs are standing up to insurance companies for denying patientsA radiology perspective
Finally, Tonie Reincke, MD, an interventional radiologist and owner of Reincke Vein Center in Sugar Land, TX, says navigating insurance is a full-time job. She has staff dedicated solely to handling insurance authorization.
“Coverage for procedures has plummeted while insurance rates rise, deductibles rise, and copays for subspecialists decline,” she says.
She often has to fight to get procedures—such as Varithena and radiofrequency ablation—covered. Insurance providers decide what is necessary, what can be delayed, and what can be treated with another (cheaper) procedure.
“It's disheartening as a physician to know that what I deem medically necessary and in a patient's best interest is often disregarded based on complex insurance algorithms that are in place to ensure maximum profits to corporations,” Dr. Reincke says.