re: A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly.

quote:

---

If my doc orders a test or procedure that he/she feels is warranted,

---

Let me expand a little bit more.

How do you feel physicians would feel about a reimbursement system that would pay them more on the effectiveness of their treatment?

So, let's say your doc orders procedures where prior authorization is no longer required and then there is a post op follow-up within 30 days of procedure and then scheduled thereafter to review success and failures. If the patient displayed improved health outcomes the physician could not only keep what they made from the original procedure but earn bonus payments along the way since that patient is now experiencing improved health BUT if the the services showed no improvement, the payment can be recouped?

quote:

---

So, if your doctor orders something that he profits from, then someone else pays for regardless of effectiveness, that should be enough?

---

If it’s medically warranted then yes. If it isn’t, he’s guilty of malpractice and neither me or the insurance company should have to pay.


Example: my brother was having some chest discomfort with exercise and was referred to a cardiologist. The cardiologist ordered and echocardiogram and cardiac CT to look for coronary artery blockages.

Echo was ok. The CT showed mild blockage that led to him being placed on a new medication and may require stent of it gets worse.

Insurance company is refusing to cover the CT and said he has to pay because it was an unnecessary test

So in short, he had a test that showed an abnormality that led to an intervention (new medicine). But the insurance company says “no we aren’t paying because it wasn’t necessary”

What kind of BS is that?

That’s the kind of thing most of us are talking about.