What happens to ethics in the medical profession when a doctor must consider what an insurance company will allow by way?

Similar questions: ethics medical profession doctor insurance company.

Its not an ethics thing, its consideration for the patient I find myself in this position all the time. I give the options to the patient. #1 - what is best but will cost you personally this much $$$ #2 - what your insurance covers, not the best but will get the job done.

If #1 is the only option available- then we write letters of medical necessity and they take a lot of time and effort from our part .

Same thing that always happens when someone can't afford the absolute best in medical care... I don't think it substantially changes medical ethics, because the problem is not a new one; it has been around forever. Newer technology and better quality treatment have long been available to those who could afford to pay handsomely for them. And -- seemingly harsh but true -- this is as it should be.

Speaking in very broad terms, wealth is an indication of community contribution. You give your money to person A rather than person B because person A is giving you more product or better service (i.e. , something that person B is not).

If the community as a whole sees person A the same way you do, then person A becomes very rich. He can afford healthcare options that others cannot -- but he got there by contributing to the community; think of his expensive doctor as a reward for services rendered, because that's what it is. Now, I'm not naive; there are other ways to get wealthy, and many who get wealthy in business are not particularly angelic.

But take Standard Oil as an example. Some if its practices were certainly unfair, and would even be illegal by today's standards. But they did provide millions of gallons of oil products to American consumers, and they did so at very affordable prices.

Even though there's some corruption in the system, the basic model still holds. They provided a service, and were handsomely rewarded for it. Returning to medical care: medical care of any kind (drugs, surgery, physical therapy, whatever) is someone's work product.

Gher quality techniques and products are of necessity more labor-intensive, and therefore command a higher price; always have and always will. Those who can afford the best will get it; the rest of us will have to make do with what we can afford. For many of us, this is what our insurance companies will allow us.

We whine about it, but how many of us ditch our health insurance? Not many, and for very good reasons. If we go through the windshield in a car accident, or develop colon cancer, that same insurance company we so love to whine about will allow us to afford a standard of care we'd never otherwise enjoy.

Think about it -- how many cancer survivors do you think there would be if they had all had to pay for their own treatment out-of-pocket? Again, I'm not naive: there will be problems with the insurance companies, just like there were problems with Standard Oil. We will need a certain measure of consumer watchdogging and government regulation for the same reasons.

But that said, insurance companies are not a threat to medical ethics. What has changed is not medical ethics as such, but the immense range and sophistication of health care options in existence. Insurance companies are slow to catch up, and necessarily limited in what they can pay for.

But every month when the health insurance bill comes, we keep paying it. There's a good reason for that.

Ethics are still there, it is the best care of patients that is harmed… It is a sad fact, but we are already in a situation where the insurance companies are already dictating what can and cannot be done. The provider’s hands are very often tied by the insurance companies. It occurs on several levels.

Please let me explain; The first level is when you actually go to see your doctor. Most insurance companies require a copay each time you go to the doctor. For several illnesses, close observation and often medication monitoring are required in order give the best patient care.

For example, the monitoring of anticoagulants, or the F/U of severe traumas are things that require many visits to your doctor. However, a $20 to $50 dollar copay is often required by the insurance companies each time the patient is seen, even when the treatment is authorized. This can be a very real stress to the patient.

Due to this, one of two things will often happen. Doctors will often extend the scheduled office visit intervals far beyond what they would consider good treatment, or the patient will simply not come in. Along with the above office visit copays to the doctor’s office are additional ancillary fees.

Most insurance companies will require some percentage of payment for things like lab tests, x-rays, physical therapy. The percentage a patient has to pay will often dictate how much ancillary care a patient will actually go to get. The next level of care that insurance companies can dictate occurs in the diagnostic related group, or DRG.

The DRG is used by insurance companies to determine what will and will not be paid for based on the provider’s diagnosis. While the provider has a lot of flexibility in what diagnosis they can decide on, the insurance companies and Medicare have the ability to review those diagnoses, so they cannot be too far from accurate. The insurance companies will only pay what they deem necessary based on the diagnosis.

If on review, or preauthorization, the insurance coder or medical review board deem that what the doctor is recommending is not necessary, it will not be paid for. I do have to say that most insurance companies are very willing to review with the doctor and patients to further understand the need for the recommended treatment. However this is not always the case.

Another similar problem is the shear amount of paperwork that is required now. Doctors and providers are so inundated by paperwork that they often have problems getting it all done. There is paperwork for the practice records, State records, Federal records, insurance, insurance carriers, employer, and the list goes on.

While this may not seem related to the question at hand, it actually is. One mistake on any one of the volumes of paperwork can result in a denial of payment. While I have never seen a doctor or provider yet that is not willing to take care of any mistakes, I have seen patients that did not get the care needed simply because they did not know that the denial was due to a mistake.

I feel this is another efficacy issue on the part of the insurance companies. In summery it comes down to this; In our current healthcare system, the costs are simply overwhelming. A procedure that should only cost a couple of hundred dollars will often cost several thousand.

A prescription that should only cost $20 will often cost several hundred. In order to pay these costs, stay in business, and provide the best possible care, insurance companies must keep track of what is being paid out. Remember insurance fraud is a big problem.

Unfortunately, this also encroaches into dictating what care is allowed. It is hard for doctors to give the care that they feel would be the best for the patient when no one is going to pay for it, and the patient can’t. I do not picture the insurance companies as the bad guys, they have to survive as well.

I picture our current healthcare system as the problem. Sources: Lots of experience Frognw's Recommendations Alternative Cures: The Most Effective Natural Home Remedies for 160 Health Problems Amazon List Price: $19.95 Used from: $2.57 Average Customer Rating: 4.5 out of 5 (based on 16 reviews) John Q. (Infinifilm Edition) Amazon List Price: $14.96 Used from: $1.58 Average Customer Rating: 3.5 out of 5 (based on 212 reviews) Our next health care system?.

Absolutely nothing should happen with regard to their ethics. No doctor I know of will change their ultimate care for the patient based on insurance coverage. Now, they may ask you to sign a waiver to be responsible for the charges if your insurance company doesn't cover the tests or treatment.

They may suggest alternative treatments or procedures if you can't afford the care plan they suggest. Many doctors will help the patient fight the insurance company with medical necessity letters so that treatment will be covered. Many will help you with patient assistance plans to get you medicine and treatment for free.So if you have any concerns that your physician will have an ethical dilemma based on insurance issues, find another physician.

Blame the insurance company Doctors are only doing what they are allowed to do. Insurance companies are for profit entities and do what earns them money. Doctors must comply with the rules and write prescriptions, determine what medical testing, surgeries and treatment is needed within the policies of insurance company.

Employees must get involved in the health care chosen by their employers. Patients must become more educated about disease states. Don't be afraid to call and make some noise when you are denied treatment you feel you need.

Chose a doctor who will stand with you! .

Those of us who have medical insurance must rely on the insurance company to give the o.k. For" "Can you collect disability insurance from your job and another insurance company" "if I have a doctor's medical marijuana recommendation and use occasionally will I get denied for life insurance? " "Is Healthmarkets insurance a legitamate company" "If you have ever had your car "totalled" by the insurance company after an accident......" "Is it a good company THE MEGA LIFE &HEALTH INSURANCE COMPANY FOR HEALTH INSURANCE." "what is the penalty for not having medical insurance in MA" "can a doctor write me a prescription online and bill my insurance.

Those of us who have medical insurance must rely on the insurance company to give the o.k. For.

Can you collect disability insurance from your job and another insurance company.

Is Healthmarkets insurance a legitamate company.

If you have ever had your car "totalled" by the insurance company after an accident......

Is it a good company THE MEGA LIFE &HEALTH INSURANCE COMPANY FOR HEALTH INSURANCE.

What is the penalty for not having medical insurance in MA.

Can a doctor write me a prescription online and bill my insurance.

I cant really gove you an answer,but what I can give you is a way to a solution, that is you have to find the anglde that you relate to or peaks your interest. A good paper is one that people get drawn into because it reaches them ln some way.As for me WW11 to me, I think of the holocaust and the effect it had on the survivors, their families and those who stood by and did nothing until it was too late.