Doctor takes on insurers over care

[Joanne98]

SAN FRANCISCO – California physician Bradley Carpentier found himself spending so much time fighting with health insurers to get approvals for the treatments he prescribed for his patients that he decided to wage his own lobbying effort.

Carpentier formed a new political action committee – Stop Practicing Medicine – to target the longstanding practice of insurers hiring doctors to review physician decisions, even though the insurer-hired doctors had never seen or talked to the patient whose care they were scrutinizing.

Insurers defend the practice, saying such doctors often serve as a second set of eyes to ensure patients are receiving the most appropriate and effective treatments. But Carpentier, along with patients and other doctors who support his position, says insurers are denying and delaying care.

“We need to let the doctor take care of the patient,” said Carpentier, a Monterey, Calif., doctor who specializes in pain management. “Pretty much, doctors ultimately do what they want, but it just depends on fighting a lot to get that done. What we’ve found is fewer patients have access to care in general because we have limited resources. We’re being kept so busy fighting and advocating for patients.”

Health insurers and doctors have long battled over care decisions, with insurers serving as gatekeepers to set guidelines and control health costs and physicians bristling at being second-guessed and overruled. The tension reached fever pitch in the 1990s when managed care was at its height, prompting a consumer backlash that led to reforms and less restrictive forms of coverage.

But Carpentier said he’s seeing an increase in pushback from health plans, prompting him to refuse most insurers and, instead, treat his patients and submit reimbursement forms on their behalf. He formed Stop Practicing Medicine, he said, to raise awareness of insurance interference as lawmakers and the Obama administration begin efforts to overhaul the health care system. The organization began recruiting patient and physician members last month.

“The prospect of health reform in this particular time in history is what led me to speak out,” he said, adding he is calling for restrictions of the practice but not the abolition of health insurers. “I think there is absolute change in the air and we want it to be for the better.”

In poll results released last month of 389 California doctors, 87 percent described limits and restrictions that insurance companies place on doctors as a major problem.

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http://www.nashuatelegraph.com/apps/pbcs.dll/article?AID=/20090614/HEALTH/906149940/-1/health

[jwirr]

1. The insurers are going to lose this argument. There are enough of

us patients that we can testify to the truth of the doctors statement.

Only one example, my daughter who has a custom made wheelchair that can be kept usable by adding new parts to a specialized frame was denied a new arm rest because as far as the insurer knew she did not have a wheelchair. Blue Cross/Blue Shield had paid for the original chair back in the 90s when they were administering MA for the state of Minnesota but when they began covering her for the county they did not take their records along. So I had to threaten them with buying a whole new wheelchair instead of a $22.00 part before they would do anything. They would not take the word of doctors, social workers, foster parents. Thus I had to threaten them with greater cost.

Insurers are idiots and if the senate goes along with them then they to are idiots.