Denied? Make Insurance Gatekeepers Responsible Too

“Snippets from the frontline” sent in from Gene Uzawa Dorio, M.D.

You’ve been told surgery required to repair a herniated disc has been denied; a mammogram to evaluate a new lump won’t be allowed; or you must be discharged from the hospital because an insurance company doctor you have never met will not approve further hospitalization.

As my patient’s advocate, I frequently must discuss their care with insurance doctors in peer-to-peer phone conversations. This is what I do starting this conversation: I get the doctor’s name; in what state they are licensed; their specialty; and tell them their name will be placed on the patient’s record as being a participant in medical decision-making.

With that, they must weigh their medical versus financial judgement, and know they might be subject to the same accountability I face. Does this make a difference? Sometimes.

Medical decision-making has been removed from your doctor and given to distant paper pushers of the insurance industry. Urge your physician in their peer-to-peer conversations to make insurance doctors responsible too.

Gene Uzawa Dorio, M.D.

Comments: http://scvphysicianreport.com/2017/07/29/doctors-diary-july-29-2017/

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Dear CNBC, Please do your research before you comment…

Dear CNBC, please be advised that before you criticize anything, you should do your research. The unaffordable careless act, known as ACA Obamacare, has changed the entire field of health insurance to few government approved and some Medicaid subsidy plans. More than half the exchange insurance co-ops started with taxpayer dollars are now bankrupt.  Most private insurers have left Obamacare exchanges leaving monopolies or even threaten to leave no insurers present to prevent citizens from being fined by the IRS for not buying nonexistent policies(see stats below). 

ACA Obamacare has trashed the whole industry and taken competition out of the equation, leaving only high prices and poor coverage. Let me know if you need anything further.

Best wishes for good health,

Craig M. Wax, DO

Family Physician

Media host

National Physicians Council on Healthcare Policy member

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Original post:

Trump trips up as he trashes Obamacare

Dan Mangan, CNBC

http://www.cnbc.com/2016/10/25/trump-says-his-workers-having-tremendous-problems-with-obamacare.html

In 6 Charts, the Rising Costs of Obamacare Rates

Without the Patient-Physician Relationship there is NO Quality Care

Open letter to patients, physicians and lawmakers from Sharon S. Jellinek  M.D.,

This is the first letter I have ever written to a political figure and I pray that someone on your staff will bring this letter to your attention.

I have been a physician for close to 30 years. I am a second-generation pediatrician struggling to keep an independent solo practice alive. Not one politician has addressed what I feel is the major threat to health care…the physician-patient relationship. Without this, there is no quality of care no matter what you do.  Physician patient relationships require time with the patient. Most of my diagnosis is derived from my patient-parent interview and a “hands on exam” of the child. You cannot possibly read a cookbook of medical questions and treatments and have the same result. The current insurance treadmill model of primary care makes this impossible. There is a hemorrhaging exodus of well-trained physicians unwilling to jeopardize this patient relationship. Continue reading

If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

Guest Post From Barbara Duck, Proprietor of The Medical Quack Blog

imageFirst question out of the barrel might be “how can that be”.  It’s really not too difficult to figure out.  A short while back United Healthcare bought a pharmacy benefit manager named Catamaran, and actually took on $10 billion in debt to acquire them.  This has been in the news for a while actually, so how did you end up with United Healthcare.  It’s easy, Catamaran is the Pharmacy Benefit Manager for Cigna, so when United bought the company, it became a subsidiary of United Healthcare, so there you go.  The company is now a subsidiary of the huge too big to fail health insurer, who actually gets 2/3rds of their revenue from insurance policies and the rest from selling software and algorithms for a big chunk of the other third. Continue reading

What’s the ICD-10 Code for Struck a Duck?

A physician writes:
A long time patient came in.  He told me he was fishing, his pole started to twitch, he turned around quickly and tripped over a duck, injuring his hip!  Never before, in my 25 years of practice, has a patient presented to me w such a c/o.
CMS lists ICD-10 codes for struck by duck and bitten by duck but I can’t find a *&#! code for struck a duck!
icd-10-duck

 

Forcing ICD10 on the American Healthcare System

“Forcing ICD 10 on American healthcare after forcing the unaffordable careless act and electronic health records, the government and insurance industry expects not to play claims accurately for quite some time.”

Craig M. Wax DO

Unaffordable Careless Act Killing Not Only Patients, But Doctors Too

The Unaffordable Careless Act has wreaked havoc in healthcare and health insurance. People pay more for their profiteering insurance plans and have higher medical bills and higher co-pays to show for it. Care and services are restricted and will be further rationed as we go along. It’s no wonder doctors commit suicide because they’re committed to their patients and the government is driving a wedge between them.

http://www.examiner.com/article/almost-2-000-doctors-have-committed-suicide-since-obamacare-signed-into-law