Doctors consider it their responsibility to encourage their patients to follow their recommendations; now they have to convince insurance providers to follow their orders as well. Dr. Stewart Segal is all too familiar with such scenarios, which he recounts in an op-ed for MedPage Today.
Describing his personal experiences as a physician, Dr. Segal illustrates the battles he has waged against insurance companies in order to provide his patients with the care they need. He explains the careful process he undertakes in deciding what medications to prescribe: considering the risks and benefits of the drug, how the individual patient will respond to the treatment, and what other medications the patient is already taking. Yet he finds that his patients insurance companies frequently refuse to cover the treatments he recommends, forcing the patients to either take a cheaper alternative (until they can prove that it s ineffective) or fork over large sums to pay for what the doctor has recommended.
And for some patients, their inability to obtain the prescribed medicine can be the difference between life and death. One of Dr. Segal s patients found that his insurance provider refused to cover a more costly drug for which there is no generic equivalent; and so, Dr. Segal notes, his patient can either pay out of pocket...or risk a ride in an ambulance or hearse.