- Health Care, Drugs & Insurance
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!