'Out of control': Cancer surgeon claims UnitedHealthcare questioned her mid-procedure

[ShazzieB]

39. I agree in principle, but there's a major power disparity in play here that can't be ignored.

In our warped and twisted "health care" system, the insurance companies literally hold the power of life and death over patients and tremendous power of another kind over health care providers and hospitals. No matter what the patient needs and the doctor wants to provide, it's the insurance company who gets to decide what actually happens, by providing or withholding coverage. Very wealthy patients who can afford to pay out of pocket when the insurance company says no are the only ones who are exempt from this unhealthy (pun intended) power dynamic.

Health care providers know this, and they have to battle it on a daily red.basis. I'm sure it has a huge impact on them. In this particular case, I suspect that the doctor felt it would be too risky to go ahead and complete the procedure without being sure that it would be covered, knowing that the patient could be thrown into a catastrophic financial situation thereby.

Also, most hospitals in the U.S. these days are (regrettably) "for profit" and would not look favorably on a doctor performing an expensive procedure for which coverage was not pre-approved and running up bills that might not get paid.

Like it or not, the health care of most Americans is now under the control of people without medical training who are sitting in offices miles from where the care is taking place and who are probably under incredible pressure themselves to decide in favor of maximizing the company's profits rather than providing the best possible care for patients.

The choice that doctor made to scrub out and take the call was far from ideal, but she may have felt that she was stuck between the devil and the deep blue sea and literally had no choice. Would she have been able to get away with not taking the call right at that moment? Maybe? But the stakes were so high that she may not have dared take that risk.

It's incredibly fucked up, but that's where we are right now, here in the good old USA.