Ester Marsh: Why are insurance companies dictating how doctors should practice?
Published 12:00 am Saturday, February 11, 2023
Since when are insurance companies dictating how medical doctors should treat their patients? I typically want to share and write my columns where people feel good after they read them, get excited about starting an exercise plan or just plain feel good about themselves. However, sometimes there is a need to address things that are snowballing out of control.
I have heard so many stories when it takes repeated phone calls, emails and frustration to get a much-needed procedure approved. And yes, I am dealing with one right now. As many of you know, I am a tonsil cancer survivor. I am 15 months out and mostly doing really well. However, within the last two months my swallowing has gotten worse and some knots and bumps have appeared in the side where my lymph nodes were removed.
I had my 3-month checkup with my surgeon and prior to seeing him, a CT scan with contrast was ordered since I had quite a bit of issues arise since my last appointment. Well, I am still waiting on it to be approved. Crazy right? I received a letter a few days ago that this procedure wasn’t medically necessary. So I called my insurance, and mind you, I have amazing insurance with our Rowan-Cabarrus YMCA. I told them that I beg to differ and that “Ester Marsh Web MD” disagrees with the denial.
After I told them my side, they understood that I do need a CT scan but the proper paperwork had to be sent in. Is my cancer back? Is it aggressive? Over two weeks have gone by and I am the one reaching out trying to get things moving, and there is still no date for a scan. I know something is going on in my neck, but I am also confident I will be fine no matter what. After an ultrasound, all my doctor found was one abnormal lymph node but needed a CT scan to see why my swallowing is worse, why my tongue is more numb and of course what’s going on with the abnormal lymph node.
Delays of important procedures like this can have a serious impact on your health.
My sister was diagnosed with breast cancer 18 years ago, with her lymph nodes being affected. From the time she had her diagnosis, her surgery for a mastectomy and lymph node removal was scheduled two weeks later. Her cancer had grown tremendously over those two weeks. So time is of great importance in many cases. I go to medical doctors who studied for many years and I trust their judgment.
The only way I can reason why insurance is “treating” me now is that there have been doctors who cheated the system. If that is the case, then those particular doctors should be reprimanded, not the entire medical system. I have many doctor friends who have told me they do more work on a computer entering the “proper” diagnosis and wording than treating the patients. Like many professions, being a doctor is a calling. We are losing them left and right and we wonder why. Well, I see one huge pink elephant sitting right here in the room.
Is there anything we, the people, can do? I wish there was. I do know however, that this system is broken. To all the medical staff out there, thank you for continuing to treat us patients. Over the years, you have become “administrators” being bogged down with paperwork instead of actual treatment of your patients. I appreciate you!
Ester H. Marsh is health and fitness director of the J.F. Hurley YMCA and “self-educated Web MD.”