As patients increasingly become agents in their own care, physicians must be the ones delivering this care — free from insurance company protocol, argues Peter Ronchetti, MD, president of Rochester, N.Y.-based Monroe County Medical Society in a Democrat and Chronicle op-ed.
Here are four takeaways from the article.
1. Health insurers' utilization management programs, which are highly manual and time-consuming processes to assess patients' medical needs, can suspend the start or continuation of patients' necessary treatment. These treatment delays could negatively affect patients' outcomes.
2. Insurance company programs may harm patients if the required therapy or injections will not change the course of their disease.
3. The concept of prior authorizations, or the requirement that physicians must receive approval from patients' health insurance plan to prescribe a specific medication, should be discussed with physicians and patients before being implemented, Dr. Ronchetti wrote. "[These authorizations] should not be dictated by how much money the insurance company allocates for a given condition, or their idea that a procedure is over utilized," he added. "In fact, this only delays care and costs both the patient and the insurance company more money in the long run."
4. Dr. Ronchetti encourages patients to ask their physicians whether the treatment they are receiving is based on the physician's clinical judgment or their insurance company's protocol. "If it's the latter, call your insurance company and let them know 'Who knows best,'" he wrote.