Insurance Woes: A Doctor’s Perspective

We have had many a dinner-table conversation about frustrations with insurance companies through the years. People bring this up with my husband all the time, I suspect hoping he has some magical solution to solve their insurance woes. Unfortunately he experiences the same issues, both as a patient and as a doctor.

For example, I recently received a letter from my insurance company telling me that blood work I had several months ago would not be covered. I have been getting the same blood work on a regular basis for the last ten years, but for some reason this one time wasn’t covered. Assuming it was a mistake easily corrected, I phoned the company and was told there would have to be a “Peer-to-Peer Review.”

Peer-to-Peer Reviews are one of the many reasons my husband is late for dinner! The insurance company actually calls the doctor and has her hold the line to talk to another doctor who works for the insurance company. The two doctors discuss why the patient needs a certain test and weather it should be covered by the company.

Think about what this means: your doctor is interrupted in the middle of a day seeing patients to wait on hold to argue with another doctor whose main interest is saving the insurance company money. Obviously your doctor thought you needed the test, or she wouldn’t have ordered it. (Contrary to what many people think, doctors aren’t getting kickbacks for tests they order.) It makes no sense. If you’re the patient in the doctor’s office, you are going to be very upset that she is running late due to taking calls in the middle of her day. On the other hand, if you’re the patient hoping that your insurance is going to pay your bill, you absolutely want your doctor to drop everything and argue your case. Your doctor does not get paid for her time during this process. This can happen several times during her day.

Needless to say, your doctor gets frustrated and you get frustrated. The system is so broken. What’s the answer? No idea, but mention “Peer-to-Peer Review” during a dinner party full of doctors and prepare yourself for the scowls and complaints and indigestion!