ryOrtho, Aug 8, 2012, BS and Stalling From Insurers
 

RYORTHO, August 8,2012 ( LINK )

Elizabeth Hofheinz, M.P.H., M.Ed. • Wed, Aug 8th, 2012

BS and Stalling From Insurers

A spine surgeon friend tells OTW, “Despite so much progress we are still being hammered by the insurance companies about different criteria for fusions. It’s frustrating for surgeons because there is good data and there are surgeons doing bad things. We operate on a different standard than heart doctors, who in many cases only have to perform one surgery. Ideally, in orthopedics one surgery would be sufficient, but as we grow older things change. Insurers don’t hold heart doctors to this standard of ‘no repeat surgeries.’

Insurance companies don’t care; they say they didn’t approve XYZ surgery because it didn’t work. But patients only stay with an insurance company for an average of 18 months before they change carriers. So the insurers don’t give a damn because some other carrier will be taking care of them.

They tell patients, ‘We will pay for anything reasonable.’ They tell doctors to write up the situation; they are just stalling the patient.

They say, ‘There is not enough peer reviewed literature.’ That is BS! Over 12 years Charité and other products have proven themselves…these are not experimental.

The issue comes down to power and money. In approximately 2003 I spoke with a PR firm in Washington, D.C. and I asked, ‘How much money is the insurance lobby spending?’ Forty million dollars was the response. When I asked what doctors would need to spend to make a dent in their efforts, the PR people said, ‘$8 million.’ Keep in mind that this was about ten years ago. Today we would probably need to spend $80 million to make a real difference.”

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