Patients and Physicians Speak Out

I am tired and frustrated by insurance companies and their ongoing denials, prior authorizations, and appeals. This is the height of crap they put patients through. As a sleep doctor, I order sleep studies based on patients’ symptoms and to rule out sleep apnea. Snoring is associated with sleep apnea and is one of its symptoms. Allied Benefit denies sleep studies if we use snoring as one of the diagnosis codes. Go figure that. One insurance [company] denied a sleep study since the term “excessive daytime sleepiness” was not used (layman term). Instead, I used hypersomnia, which is the medical term. They also now deny sleep studies and say patients don't have co-morbidities like heart attack or stroke. Treating sleep apnea is part of preventative medicine. One case, I had to call and was surprised by their rejection. When I called, the doctor representing the insurance company asked, “What is his weight?" and “Does he snore?” All these symptoms are already discussed in his clinic note. They don't read our notes. They think that if they deny, at least some doctors won't call for their patients, allowing insurance companies to save money. This is a nasty way to make billions of dollars. I feel so bad for patients who don't get adequate care on time. I myself go through this as a patient. Tizanidine, which I have ordered for patients. I myself couldn't get it, since my insurance won’t pay, and they said it will cost $400 for a few pills. 

I don't know why I went into medicine. After 12 years of education and +5 yrs of PhD work, I have to haggle with these idiots. We get health insurance to cover our health care, not for them to take the money and deny the coverage. This is what is called elite daytime robbery in the name of healthcare. They think doctors make money. Check the salaries of the CEOs and other administrators of the hospitals and insurance companies. At least pay us for education and the debts we accumulated to get here. I wish I took a different route for my career—business administration in the healthcare industry.

I represent multiple providers of different specialties. I have had it with the paperwork pushback from payors. Care is delayed and denied, and providers are made to jump through hoop after hoop just to treat patients. Starting with a reduction in prior authorizations is a step in the right direction. It's time for the AMA to truly start advocating for all the crap providers go through and put the payors in their place. Please fight to put providers back in charge of healthcare and NOT the payors.