George Harris KC Star Reader Advisory Panel

I’d like to go on record as thanking the insurance companies for keeping the government out of the middle of the doctor-patient relationship. In the consideration of health care reform, we must be very sure the government doesn't take over for insurance companies.

Just last week I spent 30 minutes on the phone with a very nice woman with an accent I mostly understood as she helped me figure out that my patient’s insurance wouldn’t pay for my services at the “in network” rate. I wasn’t on the insurance company panel, she said, so my patient would have a $500 deductible. A government worker no doubt would have made the deductible even higher.

Last year I had a lovely conversation with a medical doctor in Connecticut who was reviewing files for an insurance company. He said the psychological testing I requested approval for wasn’t medically necessary. I said that was odd because the patient’s psychiatrist had referred the patient and had specifically requested the testing to help identify symptoms that might respond to medication.

I said I had completed a psychopharmacology training program for psychologists and thought the testing would be helpful. He said he didn’t agree. I said I thought he might be practicing medicine in Missouri without a license. I added that he most certainly was practicing psychology without a license.

He said ok, he’d approve the testing. It’s really weird, but I haven’t had any more referrals from that insurance company’s network. The government probably would have sent the FBI to investigate me.

I don’t spend all that much time filling out paperwork to get insurance companies to approve treatment plans. There are only a few insurance companies that require two pages of forms for each patient every two or three weeks. And, really, if it weren’t for my disorganization, I wouldn’t get so confused keeping track of a different form for each of the fifteen or twenty insurance companies whose patients I see.

The government form would be much longer, I’m sure, and in triplicate. I work with only one company that requires four copies, but they provide the forms, so all I have to do is separate them. Well, I have to recopy everything onto the fourth form because I can’t write hard enough to make the last page clear, but this is a minor annoyance to be able to work with private enterprise.

It’s little known to the public that the contracts doctors have with most insurance companies prevent doctors from providing services not approved by the company even if patients agree to pay for the services themselves. You might think that would be an unreasonable restraint of trade. But think what the government would do. They’d probably prevent doctors from providing unapproved services even if the patient agreed to pay.

Wait, that’s what the insurance companies do. OK, so there’s a toss-up here, but if the government did it to me I know I’d be more upset about it.

My own insurance company last year decided I didn’t need a medication my doctor had been prescribing for ten years. It wasn’t approved by the Food and Drug Administration for my medical problem, they said. See? There’s the government interfering in my life again.

I looked, and there aren’t any drugs approved by the FDA for my medical problem, and I appealed the insurance company’s decision. I was sure they’d reconsider when they found out it was the government’s fault, but no luck. I sent the letter of appeal and never got an answer. The government would have sent a nasty reply.

So, don’t let the government get between you and your doctor; the insurance companies do it much nicer.