Entrepreneurship tug-of-war at play here.
This is an astute observation, which points out that the insurance company must watch its expenses and ensure no frivolousness occurs.
That said, who makes the final decision here? THAT’S the problem.
Patients pay their insurances because they want tests ordered by their trusted doctor to be covered.
When the insurance says no, they’re forced to pay out of pocket if they want things done.
Who says no, though? A third party human, who sometimes isn’t even a doctor. And certainly someone who isn’t at the actual visit.
Doctors must nowadays essentially “go to court” to argue on behalf of their “defendants”. Unpaid work, mind you, as a patient pays for their visit, but not for the work doctors put in as “defense lawyers”.
Additionally, doctors aren’t trained in this. We don’t get schooled on law.
Should there, on that note, be a new class implemented into the medical school education called “Fighting with Insurance 101 and Winning”?
Or “The Anatomy of a Prior Authorization Battle”?
These are legitimate concerns physicians today face. And those who suffer most because of it - patients.
This is why I am so drawn to the private practice models gaining in popularity, where doctors are paid out of pocket and arrange for services and medications that are much more affordable and do not require insurance coverage.
Medical insurance should be used in the same way car insurance is - catastrophic coverage.
Head, Global Patient Advocacy and Policy at argenx
3moThe CIDP Patient Community is excited to have an innovative Treatment Option to consider !! Many thanks to the diligent work of the Halozyme Team to make this possible!