Afraid Of Death Panels? Health Insurance Companies Already Have Them! Don't Become A Victim!

Death Panels Already Exist! They Are Called Utilization Management!

Death panels! Oh, No! That over-reaching and intrusive Federal Government! Trying to get between a doctor and patient! How dare they? Decide who lives or dies? Well, guess what? Death panels are already a reality and not just paying for end of life discussions with your doctor as was proposed in the Health Care Affordability Act. People need to realize that death panels exist at every private insurance company in this country! They have NOTHING to do with President Obama! They have nothing to do with health care reform. They are called utilization management or utilization review departments. They are the insurance company employees that decide, based on medical information submitted by your doctor, whether you will receive a certain treatment or not. They make these decisions based on cost versus probable outcome. How many days are you allowed to stay in the hospital? Are you allowed to have a surgery suggested by your doctor? Is your chemotherapy going to be approved? Will you be allowed to have a CT scan or MRI? How about that liver transplant?

What Is Utilization Management And How Is That A Death Panel?

Insurance companies only generate a profit if they control costs. When they spend more on care than they bring in, they go out of business. Every insurance company has a utilization management division. Utilization management is defined by Wikipedia as the evaluation of the appropriateness, medical need and efficiency of health care services, procedures and facilities according to established criteria and under the provisions of an applicable health care plan. Further, it is a process of integrating review and case management of services in a cooperative effort with other parties, including members, groups, providers and payers to optimize the appropriate placement of patients to receive appropriate services/supplies.

To summarize, utilization management is a committee, so to speak, of health care professionals and lay people that creates guidelines for dispensing treatment in an efficient, cost effective way that provides care but saves money. There is no mention of UM providing the best care, but the most efficient care.

Take note of your benefits manual. If your insurance company requires pre-authorization, your insurance carrier has a UM division. The UM department creates a list of guidelines that must be adhered to for any given scenario. If you have a stroke, there are a certain number of hospital days that you are allowed. In addition, age becomes a factor in all guidelines. Current medical condition also becomes one of those guidelines.

To illustrate: 17 year old Nataline Sarkisijian was a leukemia patient. According to her doctors at UCLA Medical Center, she required a liver transplant to survive. Nataline would definitely die without a new liver and Cigna originally authorized the surgery. When Nataline developed a lung infection, her liver transplant was denied with Cigna stating that the procedure was experimental. Her doctors and family appealed the denial and contacted the media. Nataline was in ICU for 10 days waiting, with her medical condition deteriorating while her insurance company pondered the evidence for the appeal. Finally, when a protest took place at the Cigna offices in Glendale, California, under the glare of television cameras, Cigna changed their mind again and approved the surgery. Reports state that Nataline's 10 day stay in ICU was too long. The delay caused her condition to deteriorate so badly that she died prior to getting the transplant.

This is a well known illustration because it received so much press. There are other examples that have received media attention. A particularly eye-opening article written by Mike Madden for Salon.com goes even further. It outlines UM denial or delay of care in 5 patients. You may link to it at: http://www.salon.com/news/feature/2009/08/11/denial_of_care.

Insurance Company Death Panels Do Cause Deaths!

Because private insurance company statistics are not required to be made public, we have no way of calculating or monitoring just how many people die annually or are denied necessary treatment at the hands of the insurance company death panels. These panels ration and measure care every single day and no one is up in arms about their decisions. Individual patients fill hundreds of websites complaining about denials of medications their doctors want for them (too expensive), denials for hospital stays (too expensive) , denials for certain tests (too expensive), but their complaints go no where. In the few cases where the families contact the media to beg for help, denials are many times overturned. Why so little outrage over the real death panels?

I served as a UM coordinator for a small IPA that served a little over 100,000 patients. I saw denial after denial, based on age, cost of treatment, etc. These denials ranged from small requests such as a referral to a specialist all the way up to denial of spinal cancer therapy because of the cost vs. outcome variable. I additionally saw denial of monthly lupron injections for a terminal prostate cancer patient. His doctors thought he had about 2 months to live and the lupron (a palliative treatment) would help with the patient's severe pain. Because the shots, given monthly were $800.00 each, they were denied because they did not add to a cure of this man's terminal disease. This case stuck with me all of these years later because he was the father of one of my childhood friends.

I had the authority to approve emergency authorizations if none of the doctors on the committee were available. I had to follow the same guidelines that the physicians did, but I was not a doctor, not even a nurse. One day, I received a call from a primary care physician requesting an immediate consult with pulmonary medicine for his patient who had stomach cancer. The patient was experiencing chest pain and the treating physician and I both thought the patient may be suffering from a pulmonary embolism. I tried to reach the physician on call, but he was unavailable. I approved the authorization and 30 minutes later, I approved the emergency ambulance that took this man to the hospital for the emergency admit that I also approved. The diagnosis of pulmonary embolism was correct and quick action saved this patient's life. Even though I followed guidelines to the letter and continually tried to reach the doctor on call, I was in big trouble! The cost vs. outcome was not considered. This patient had terminal stomach cancer. I was told that the patient was going to die anyway and the emergency treatment I had authorized was not cost effective. How is that for a death panel?

These things happen daily, but on a much more significant basis than I dealt with. Thousands of decisions are made every day and thousands of patients daily are denied treatment that their doctors request. Where is the outrage?

Misplaced Rage By Uninformed People! What A Travesty!

When millions of people across this country protest a simple end of life discussion between a doctor and patient but do not stand up and protest the real death panels that exist at every insurance company, I am baffled!

People have end of life conversations every day with their doctors. Every day people draft living wills and there is no problem. Everytime a diagnosis of cancer is given, there is an end of life discussion. But when someone misinterprets a provision that allows payment to a doctor for that conversation, all hell breaks loose! That conversation between doctor and patient must be a death panel waiting to happen! And yet the real death panels go on with no complaints from those same people.

Are people just unaware of how private insurance companies are operated? That is the only answer that makes sense. People must not realize that this happens. It does. Where is the outrage?

As a side note: I have written many articles on health insurance and have recently noticed that some of those articles have been reprinted, without permission, without being attributed to me. One of the sites that is guilty of this is a foreign company currently being investigated by their own country for fraud. They are using one of my articles, with my name removed, to entice people to sign up for their services. Please be cautious when seeking assistance with your health insurance problems. Not all companies are above board. If they steal writing, imagine what they will do with your money!

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Comments 11 comments

arb 5 years ago

Hi Jillian! Wonderful and spellbinding information. When Ins co can be held liable and sued for complicity, then we will see change. How does David fight Goliath? We need to throw more rocks. This is one.


HSchneider 5 years ago from Parsippany, New Jersey

The right wing PR campaign against the Healthcare Reform Bill operated by pouncing on anything they could twist to their advantage. Truth and honesty never entered into the equation. Since the insurance companies are private enterprise, they do not fit into their death panel narrative. Thank you for pointing up the obvious that profit driven insurance companies cut costs by having panels decide and deny procedures. Also the discussion between doctors and patients for living wills are standard when getting a procedure or operation. Take these bits of truth Sarah (Bag Me a Moose) Palin.


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Dear Arb and HSchneider,

Thank you for your comments. When will we realize that the words medical care and profit should not be in the same sentence? Don't think any of us will see that day.


Pixienot profile image

Pixienot 5 years ago from Clarksville, Indiana

You are right!! Most just don't know and sadly, don't know they don't know.

I worked for a health ins and my boss was the UM. One day a lady about 30 years old came in and asked for a breast reduction. Her mother and her sisters and aunts all had died from or were suffering cancer due to greatly enlarged breasts. Hers hung below her waist.

She was denied. She appealed (I forget how many times) and still was denied.

One day the office staff was to be on alert as this woman was in the building and might have a gun - she was so desperate.

She came and went in peace with her final denial.

Six months after her first request she developed breast cancer. And even then it was too late to save her life with a reduction. So her three children grew up without her.

This is a travisty and an outrage. I hated my job from then on. Yet it would be many years before I could leave it.

Thank you for your most enlightening piece.


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Dear Pixienot, I am so sorry to hear about your awful experience. Her poor babies! Those things we never forget, yet the executives who make these guidelines, never give it a second thought. My UM boss used to have a favorite saying, "Too bad! So sad!" as she would deny possible life-saving treatment. Worse, she had a smile on her face. Profit is a great thing, but health care and profit together? Too much needless suffering...


2patricias profile image

2patricias 5 years ago from Sussex by the Sea

This is all very interesting. We live in England, and find it hard to understand the debate in the USA about health care. We eventually grasped that the legislation is more about health insurance than health care.

One of the many mysteries is this idea of 'death panels'.

Pat's 93 year old neighbour has just come home from a 4 week stay in the hospital. While there she was offered a procedure that might have improved her cardiac health - we 're not clear on detail because the lady decided against having any treatment.

We both think that our National Health Service is very good. It's not perfect, but most of the time it works well. It appears to us that there some of the stories that have been told in the USA are based on misunderstanding or myth.


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Dear 2Patricias,

You have no idea how much I appreciate your valuable input!

I have done a bit of research into the health care system in England and from what I have seen, it seems to work. There are many stories in the US that are perpetuated and are based solely on myth and not just with health care. No system can be perfect because it always has the human error factor involved, but in my country, denial and rationing of care happens on a daily basis and many people here don't even know it. And the charity care that we are told about constantly; it is a joke!

Medicine is big business in the US, huge business! And I believe it is inexcusable to generate enormous profit from the illness of others.

How I wish that we, in America, could grow up and join the rest of the advanced countries in the world and allow all our citizens to access necessary health care.

Thank you, again! Maybe if we could hear more of what you have to say and less of what our 'enlightened' politicians have to say, we would get it right!


someonewhoknows profile image

someonewhoknows 5 years ago from south and west of canada,north of ohio

It all seems to come down to money and ethics


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Dear someonewhoknows,

It always does, doesn't it?


homebuilding 5 years ago

0Thank you, so much, Jullian.

I, too, have had very direct experiences, over fifteen years, advocating for persons lacking health insurance or who were being denied benefits by a private bureaucracy motivated primarily by their profit motive.

We've all heard the oft-repeated lies of the anti-universal care propagandists--how Canadians run to the U.S. for 'good care,' and how Brits must wait for years for surgeries.

How inconvenient are the facts, though !

Residents of universal care countries universally have a longer life span (than in the U.S.) and the mortality rate of their infants is lower, as well (many, many studies and observers note this--it is NOT a new or controversial discovery)

Right to lifers: COME FORTH ! !


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

You are welcome, homebuilding! Thank you for being an advocate for those needing care! We are few, but cannot stop! It is too important!

Until profit is separated from health care, the system will be inequitable. Your health care should not be determined by how much an insurance company will profit by denying care!

Right to lifers? Have asked many why they are unconcerned with this vital issue. They never answer. They seem to have tunnel vision. They fight for life until the life is born...

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