Sunday, June 05, 2005

Our Modern Heath Care System

Next week my wife is going to have a hysterectomy. She's had really bad pain now for years, and has tried nearly everything to avoid the surgery her doctor recommended six months ago after she had a laparoscopy to confirm a diagnosis of endometriosis. Which it didn't. Instead she has a condition called adenomyosis with adhesions on her uterus, which is similar, but different. And painful. Her doctor has told her it will be a fairly involved surgery, with three, maybe four, nights in the hospital and a lengthy recuperation.

So, like any surgery in our modern health care system, we had to get the surgery pre-certified by our insurance carrier. Now you'd think such a precertification would involve checking to see if her doctor and hospital were in the approved service provider network, if the surgery was covered by my plan, and if the procedure involved was up to acceptable medical practices. But instead, as spelled out in the letter of precertification, the process seems instead to focus on diagnosis and treatment:
While we have recommended an original confinement of 2 days for this admission, we understand that additional days may be necessary. This allows us the opportunity to monitor your progress with your physician and the hospital, as well as better assist with any discharge planning needs.

My insurance company is going to monitor my wife's medical progress with her physician? Are you kidding me? That's what I want. Her doctor, a trained M.D. and OB-GYN who knows my wife's medical history (not to mention what her uterus looks like first hand), is going to check with an insurance company about the doctor's prescribed treatment? Some bean counter with minimal medical experience, not anywhere near the hospital, is going to determine with her physician the best plan for her discharge? Again, are you kidding me? Why not just involved me in that decision as well. I'm sure I'm qualified. I am a guy and all.

The doctor recommended three, maybe four, days stay in the hospital, but the insurance company recommends two? Recommends? Boy they sure are swell to understand that additional days might be necessary. How do they know that two days is all that's needed? Statistical averages? Who they hell are they to recommend anything? What if her doctor is not sure my wife is ready to go home, but rather than fight with the insurance company and enduring the associated paperwork to justify an added day as "medically necessary" to the insurance company, she just discharges her? What if my wife is discharged per the insurance company's recommendation, and has complications at home? Again, don't I as her husband have any say in this too? After all, I am a guy remember.

What's wrong with this picture? Now I have no doubt my wife's doctor will do the right thing, and have no doubt my insurance carrier will cover anything asked for. But that's not the point. When did we as a nation, so proud of our private for profit health care system, come to accept that medical treatment decisions should be made by anyone other than the patient and their physician? When? When are we going to pull our heads out of the sand and realize insurance companies are for profit corporations not health and wellness organizations.

I may be a guy. I may be her husband. But decisions about my wife's medical treatment are not something I should have much if any say in. Neither should my insurance company.