Virtually every doctor has cursed the process by which health plans review their decisions and approve or disapprove of treatments--usually without having ever met or even spoken with the patient.
One day, Monterey, CA-based physician Bradley Carpentier decided he'd had enough. Carpentier has formed a new political action committee--dubbed "Stop Practicing Medicine--to fight the practice of health plans hiring doctors to review outside physicians' decisions.
Carpentier's not alone. In a poll released last month by the California Medical Association surveying 389 California doctors, 87 percent said health plan limits and restrictions were a major problem. And 86 percent said they'd selected treatments that they might not have otherwise due to health plan pressure.
While insurers say that the process makes sure that patients get appropriate care, Carpentier argues that health plans are simply denying and delaying treatments to save money. He argues that fewer patients have access to care, in fact, because doctors spend so much of their time fighting with insurers. He says that now is a good time to look at the issue, given that health reform is in the air anyway.
In his own practice, Carpentier has gotten the sense that health plans have become even more aggressive of late, causing him to break off contracting with them and instead, treat patients and submit reimbursement forms for them.
To learn more about this effort:
- read this San Francisco Chronicle piece