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Criminal Malpractice?

It used to be that your doctor, who knows you and your medical history, made the decisions about your medical care. Today, a top cardiologist might make such a decision, decide on a certain procedure, but then must get approval from an insurance company. Procedures deemed necessary by the doctor are often denied.

So, insurance companies are practicing medicine without a license! That used to be a crime. What’s going on here?

Sure, insurance companies have doctors on staff to set up and adjust the rules used by the computer systems that make the decisions. But, the computer systems base decisions mainly on actuarial tables and statistics, not on medical knowledge, and certainly not on familiarity with the patient and their particular problems. The decision is not made by a doctor.

Even if a doctor becomes directly involved in the decision on a certain case, that doctor doesn’t know the patient and isn’t interested in the patient. That doctor wants to keep his job, to keep his employer happy. What’s more, such doctors are clearly less qualified and less experienced than a cardiologist who makes these life and death decisions every day. They’re not real doctors. They’re people who have earned a doctorate in medicine but are working for insurance companies and not practicing with real patients like a normal doctor.

An insurance company is not a doctor and yet it practices medicine. Is a crime being committed right under our noses, but we don’t recognize it as such because of the complicated context and acceptance of the status quo? Everyone’s doing it so it must be okay.

2 Comments

  1. I’m sure they get away with it by stating they are making financial not medical decisions and that the doctor is still able to operate and make other financial arrangements with the patient.

    • I wonder. I was hoping to stimulate some discussion about this. Maybe a doctor who’s in this situation can jump in. My understanding is that most doctors, like cardiologists, work in large medical institutions and hospitals, where their hands are tied. What the insurance company mandates for the patient is what goes and no other arrangements are possible. But, I’m sure I don’t have the whole picture.

      I’d love to hear from some people with direct knowledge.

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