Even doctors fear coverage denial
As a cardiologist, I offer some food for thought on David Lazarus’ column “Is this a healthy way to choose who gets care?” (Consumer Confidential, Jan. 20).
I help my patients in their appeals to insurance companies that deny coverage. The “system” where “appropriate decisions are being made,” according to Dr. Alan Sokolow in the article, is one in which conflicts of interest abound and where policies are purely internal.
For example, I am currently helping a patient for whom I recommended a CT angiogram in March 2007. Her insurer denied the coverage months after the scan was performed.
In the denial letter, the guidelines cited for justifying the denial were the insurer’s own, not those adopted by the American College of Cardiology or the American Heart Assn.
As someone who purchases health insurance for my family, I sometimes feel that I’m trading the fear of possible financial devastation from a catastrophic illness for the fear of having to fight my insurer for coverage should I or my family ever have to make a claim on our policy.
Raymond S. Yen, M.D.
San Dimas
David’s Lazarus’ Sunday column was a classic example of not letting the facts get in the way of the story. Filled with unsubstantiated insinuations and illogical conclusions, it ignored much of the truth regarding Blue Shield’s claims payment process and engaged in disparaging innuendo about an excellent physician.
Blue Shield uses a wide range of medical experts in a variety of specialties to develop medical policies designed to help our members get the most appropriate care. Specifically, our policies concerning MRI and other scans for breast cancer screening and monitoring follow national standards.
Blue Shield’s medical directors are qualified physicians from various specialties who apply our policies based not only on their own expertise, but on that of other specialists who are consulted routinely. Just as physicians do in other settings, a single doctor will sign a communication that may reflect the input of numerous others.
All of this information was provided to Mr. Lazarus, who chose not to share it with his readers. In this and other columns, Mr. Lazarus promotes a “single-payer”-style healthcare system, one that would surely feature -- as it does in other countries -- limits on utilization at least as strict as those applied by any private health plan in the United States.
Times readers would be well served by a thoughtful examination of how health plans operate. Instead, Mr. Lazarus has provided an ill-conceived attack piece.
Alan Sokolow
Chief medical officer
Blue Shield of California San Francisco
