I just got burned again by Pacific Care, a particularly woesome managed health care company. More accurately, I should say, another of my patients got burned.
I have come to hate health insurance companies.
I hate how they masquerade as anything other than what they are - a business whose sole aim is to make a profit. Period.
I hate how they try to convince the American public that they care first and foremost about health and establishing meaningful relationships with trustworthy doctors.
I hate that in this age of preventative care awareness that they've managed to thwart or twist this concept.
I just hate that I have to justify treatment of my patients to random "case managers" working for a corporation. The case manager gets involved in a patient's care when there is a threat to the corporate ideal of how much money should be spent on any given patient.
I hate that these "case managers" or even sometimes hired-gun physicians are sitting in a sterile corporate office and have no actual interaction with my sick patients... yet have tremendous power over the type of care I can provide.
But then again, who am I to complain when a random employee hired by Pacific Care is telling me that she feels my patient ought to be transferred to a lower acuity of care (read: less expensive). If the case manager dare "authorize" an appropriate amount of time in an in-patient setting for treatment of a severely ill, alcoholic, depressed, anorexic woman... that might mean the Unemployment Line for Ms. Pacific Care On-The-Phone Case Manager. My patient, after all, is only a 25 year old mother who mustered up the courage to get herself some help before she damages yet another life... her 11 month old daughter's. Pacific Care is convinced my patient needs only one week in a treatment facility for Eating Disorders. How dare I recommend three months. Who am I to think that "it's ok" if my patient is not ready to be put on multiple medications and pumped up on major doses of Prozac? And then, with an ominous sound of typing personal data into a computer while "reviewing the case", Pacific Care, tells the patient, "too bad, we aren't funding your care further." And my patient drops out of treatment. Excellent work Pacific Care! You just saved yourself a bucket of money. Oh, and by the way, you've geometrically increased the chances for my patient's infant daughter to be negatively impacted by increasing her time with a depressed, alcoholic, anorexic mother. But who cares, the 11 month old isn't paying the premium. I'm sure my patient will continue in her spiral downward. She may further lose her ability to function in the world, and eventually lose her insurance coverage altogether because she will lose her ability to be employed. And that's a Bonanza to you Pacific Care! Then Medical/Medicaid will take over and she'll just become a burden to society. And Pacific Care will be off the hook. Congratulations, you win. Society, the patient, and caring doctors lose.
Having said that, I do have a basic understanding of the history of why the managed care industry established in the first place. I just don't think it is a system that is working for the average American who comes down with a major medical illness, or God forbid, a major mental illness.
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