132
Doctors With Histories of Big Malpractice Settlements Now Work for Insurers
(www.propublica.org)
you are viewing a single comment's thread
view the rest of the comments
view the rest of the comments
this post was submitted on 17 Dec 2023
132 points (98.5% liked)
News
23406 readers
1638 users here now
Welcome to the News community!
Rules:
1. Be civil
Attack the argument, not the person. No racism/sexism/bigotry. Good faith argumentation only. This includes accusing another user of being a bot or paid actor. Trolling is uncivil and is grounds for removal and/or a community ban. Do not respond to rule-breaking content; report it and move on.
2. All posts should contain a source (url) that is as reliable and unbiased as possible and must only contain one link.
Obvious right or left wing sources will be removed at the mods discretion. We have an actively updated blocklist, which you can see here: https://lemmy.world/post/2246130 if you feel like any website is missing, contact the mods. Supporting links can be added in comments or posted seperately but not to the post body.
3. No bots, spam or self-promotion.
Only approved bots, which follow the guidelines for bots set by the instance, are allowed.
4. Post titles should be the same as the article used as source.
Posts which titles don’t match the source won’t be removed, but the autoMod will notify you, and if your title misrepresents the original article, the post will be deleted. If the site changed their headline, the bot might still contact you, just ignore it, we won’t delete your post.
5. Only recent news is allowed.
Posts must be news from the most recent 30 days.
6. All posts must be news articles.
No opinion pieces, Listicles, editorials or celebrity gossip is allowed. All posts will be judged on a case-by-case basis.
7. No duplicate posts.
If a source you used was already posted by someone else, the autoMod will leave a message. Please remove your post if the autoMod is correct. If the post that matches your post is very old, we refer you to rule 5.
8. Misinformation is prohibited.
Misinformation / propaganda is strictly prohibited. Any comment or post containing or linking to misinformation will be removed. If you feel that your post has been removed in error, credible sources must be provided.
9. No link shorteners.
The auto mod will contact you if a link shortener is detected, please delete your post if they are right.
10. Don't copy entire article in your post body
For copyright reasons, you are not allowed to copy an entire article into your post body. This is an instance wide rule, that is strictly enforced in this community.
founded 1 year ago
MODERATORS
I don't like insurance companies. But the skills required for surgeon vs medical director are vastly different. Lacking the skill to perform a surgery doesn't preclude the knowledge of medical necessity. I don't have any problem with someone switching careers when one clearly isn't working out, especially when the one not working out is 'surgeon'.
Except these physicians are often completing something called a "peer-to-peer" on behalf of the insurance companies, not just making broad treatment decisions. This is a process by which an ordering physician is required to call a physician employed by the insurance company to justify a testing or treatment course to their "peer". Unfortunately these "peers" are often composed of physicians who did not complete residency and/or who do not currently practice, let alone in the specialty of the physician who is required to call for the peer-to-peer.
This leads to rather absurd results in which a board certified, practicing sub specialist (cardiologist, neurosurgeon, oncologist, etc) with 5+ years of specialized training after medical school has to convince a physician who may never have even practiced that they know what they're doing. I personally think if you're not a neurosurgeon, neuroradiologist, or neurologist then you aren't really qualified to cancel a neurosurgeons MRI, but hey, I don't get a bonus for denying claims.
From what I can tell, those peer to peers are primarily used to make the physician decide he doesn't want to waste the time doing a peer to peer. You'll eventually get to the point that the insurance company WILL be liable for adverse outcomes for denying the intervention, and they want to toe as close to that line as possible.
No the insurance company is basically never held liable (at least to the best of my knowledge). They claim they aren't dictating care, just determining whether or not they would pay, and that the patient's treating doctor should be the only one liable even if the insurance company denied coverage for recommend treatments or tests that would have prevented the adverse outcome. People have tried to sue them for delays in care they've caused but generally unsuccessfully as far as I know. Unfortunately insurance often denies payment for very needed care even after many appeals and prior auths and tons of other bull. So yes they are trying to waste time and hope the doctor doesn't try to go through appeals and peer to peers and things (that eat up many hours of time and end up costing the healthcare system as a whole even more money), but there's no guarantee they will come around and actually pay up in the end even if that's all done. And they aren't held responsible even if they effectively prevented needed care by refusing payment. They're a cancer on our healthcare system.