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AFTER TRUMP: A Healthcare Story

FacebookBarbara Stoner  This, from a friend, with his permission:

So, a big part of health care costs are radiology tests like CT scans and MRI’s. So insurance companies hire executives whose job it is to get those costs down. Their strategy has generally involved making every high-dollar imaging study go through a prior-authorization process. So if I see someone who needs a test, we have to submit their information to the insurance company and it’s either approved or denied, and if it’s denied then my only option is to personally have to call a call center and try to convince someone to approve the test.

I think they’re thinking that if they make it hard enough, we just won’t do the test – which, if you think about it, is insane – what doctor worth their salt is just going to say “okay, it’s too hard, Ima just let this guy die of appendicitis.”

The other day I had an 88-year-old woman with an abdominal tumor I could feel, so I ordered a CT scan, which was denied, then I had to wait on hold for 1/2 an hour for a guy to come on and tell me he still wasn’t going to approve it, what I SHOULD do is a trans-vaginal ultrasound and a colonoscopy. Beside the fact that it’s the wrong thing to do and an 88-year-old woman isn’t going to agree to a trans-vaginal ANYTHING, a colonoscopy is actually more expensive than a CT, which I tried to inform the moron on the other end, to no avail. So what did I do? I admitted her to the hospital, where she could get the appropriate tests. Which wound up costing 10x as much as if they’d just approved the CT. But the executives that are implementing these denials are getting bonuses. Why? Because their only job is to make sure the cost center of outpatient radiology is going down.

Nevermind if it makes other cost centers explode. That’s why Dr. Dipshit wanted me to get a (more expensive) colonoscopy – it would make it look like he was saving money, since there were lower outpatient radiology costs. Meanwhile their efforts have also required the hiring of additional people on both ends – on my end, trying to get approvals, on their end, trying to deny tests – and these are all people who are not involved in actually taking care of patients. All of this adds to the cost that you and I pay for our premiums.


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