Over the last decade, insurance companies have increased their profit margins by denying medical care. They realize that physicians are extremely busy and don’t have the time to do a peer-to-peer reviews for denied claims. When the physician does have the time to a do a peer-to-peer review they make it very onerous for the physician to speak with the physician from the insurance company. This is a waste of time and health care dollars. Sometimes to make the correct diagnosis the physician has to order certain tests such as an MRI. Sometimes even with an MRI we cannot be certain of the diagnosis. The insurance companies will frequently deny the MRI and ask the patient to undergo physical therapy. Unfortunately, the majority of the time when the physician doesn’t know what the real diagnosis, physical therapy may not be helpful initially. As an example, a relative of mine recently experienced sudden foot drop. I told her to try and walk it off but the foot drop never improved. So we wanted to obtain an MRI, however the insurance company insisted that she needed 6 weeks of physical therapy before she could obtain an MRI. We waited 6 weeks and unfortunately she had to undergo emergency surgery. Two hours after the surgery she was much improved. Not everybody can be as lucky as her. Other times patients will suffer irreversible damage before they can obtain the necessary care. Insurance companies get around this legally by stating that the patient can have any test they want however they are not going to pay for it.
I have no idea how the insurance companies illegally practice medicine and mandate patient care. The Attorney Generals of both West Virginia and Ohio should go after the insurance companies for practicing medicine without a license and the Governor or the State Legislature should pass rules and regulations to limit this behavior. There is a lot of money wasted and harm being done to the people by these insurance companies.
Recently Patrick Morrisey, the Attorney General for the state of West Virginia asked the insurance companies to help with the drug epidemic in West Virginia. First of all, the majority of the overdoses in our area are caused by the wrong mixture of Fentanyl and heroin, and not by prescription narcotics. Asking the insurance company to help with the drug epidemic is like asking the raccoons to come with the foxes to guard the henhouse. The insurance companies simply began to deny any patient with chronic pain opioids for pain management. There are quite a few people who are legitimate users of narcotics for pain management and now the insurance companies won’t pay for it. So thank you Pat Morrisey for not addressing the real problem. The old adage of be careful when somebody says ‘I am from the government and I am here to help you’ keeps ringing true.
George Tokodi, D.O.