The Doctor/Patient Relationship and Insurance Companies

In Breast Cancer, Recent Posts by Barbara Jacoby

For the last several years, I have wanted to find ways in which to enhance and improve the doctor/patient relationship on all levels. To me, when a patient is provided information regarding their possible choices with regard to treatment options and such options are discussed with their medical team members, the patient not only is more likely to follow the course of treatment as outlined but also will have a much greater trust in their medical team members. And should the patient have problems and questions along the way with the course of treatment, that patient is much more likely to speak to their doctors about those issues so that changes and/or adjustments can be made that result in the most successful outcome possible. However, what happens when that doctor/patient connection is breached, especially when it happens as a result of an outside force over which it seems that neither doctor nor the patient has any control? Such seems to be the case more and more often these days as a result of the intrusion of insurance companies into the treatment approval process.

No insurance company should put itself in a position to delay or change a treatment for a cancer patient or to interfere with the doctor/patient decisions. Barbara Jacoby

In researching this matter after having had discussions with both cancer patients and doctors, I found an article that shares some interesting insights into what happens when an insurance company denies a doctor’s request for a treatment authorization. As the article points out, it is one thing if a treatment denied is for perhaps a recommended acne treatment but if a treatment is recommended by an oncologist, the issue is entirely different. A patient’s oncologist is the only source of a complete history of the patient and is the only one who is a position to recommend the best treatment option for that patient. Most likely, if the patient is fortunate enough and interested enough to have engaged in discussion about treatment options before a final decision is made, the patient and doctor have agreed not only about which treatment is most likely to provide a successful outcome but also have created a relationship of mutual trust and hope for the future. But, if the insurance company representative then denies the treatment, an irreparable outcome most likely will result and this can happen on so many levels.

For the doctor, this may result in hours and hours of work for everyone to deal with the paperwork necessary to file the objection to the rejection and justification for the recommended treatment that may cause an unnecessary delays for the patient. Not only does this cause delays in treatment but may ultimately result in the doctor having to select another treatment that would never have been even close to what was requested but the only one that will be approved by the insurance company. And at this point, how can the doctor begin to explain the change to the patient when it is something that even the doctor can’t begin to accept?

As for the patient, delays cause anxiety and frustration and, even worse, doubt that the doctor knows what the right treatment may be. After all, if the insurance company denies the treatment for reasons other than it is something that is not covered by the patient’s insurance plan, then the patient may believe that the selected treatment may be the wrong one. One might assume that the insurance companies have guidelines that recommend the “best” treatment for your particular type of cancer under these particular circumstances based upon years of gathering statistical information from thousands of other patients and perhaps their proposal is better than that submitted by their own doctor. And so goes, the doctor/patient relationship right down the drain and the patient’s commitment to the treatment that will ultimately be given!

While there will sadly always be a few doctors that will abuse the system, more than likely this will not be the case with a doctor who has treated the patient with respect and dignity and has taken the time to put them at ease during the process of determining a treatment course. And while I understand that insurance companies are “businesses” that need to have someone keeping an eye on the bottom line, I am suggesting that when it comes to treatment of cancer patients, that covered, doctor-requested treatment programs be always approved. Every single cancer patient’s cancer and situation is as individual as their fingerprint and the only person who is in a position to make the very best assessment of a patient’s needs is the oncologist who has all of the available patient information at hand in one location.

If we allow our oncologists to do their job, this needs to include the doctor/patient mutual decisions that include patient buy-in to be the controlling factors in treatment. No insurance company should put itself in a position to delay or change a treatment for a cancer patient or to interfere with the doctor/patient decisions. This is in the very best interest of the doctor and the patient on every level and very honestly, in the best interest of the insurance company as well. After all, these decisions may be a matter of life and death and no insurance company should put itself in a position to be held responsible for the outcome of a delayed or altered treatment decision made by a patient’s oncologist under any circumstances.