Even doctors have trouble getting necessary procedures approved by insurance



It’s not simply peculiar individuals who generally need to struggle with their insurance coverage firm over obligatory procedures. This occurred with Mercer Island MD and common visitor of Seattle’s Morning Information Dr. Gordon Cohen, who joined the present to debate his personal expertise.

“I had a situation referred to as cervical stenosis. It’s really the second time I’ve had it. It really occurs fairly continuously in surgeons — the truth is, some individuals name it surgeons’ neck — I had a narrowing of the house the place the sixth cervical nerve root comes out between two bones,” he mentioned.

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“And so three years in the past, once I had an issue, my surgeon Dr. Addison Stone — who I feel is without doubt one of the greatest surgeons within the nation — enlarged the world across the nerve by reducing away bone,” he defined. “And in order that was a minimally invasive process.”

Whereas he has some reduction for years, the issue got here again, and he had hassle getting a second process accepted by insurance coverage.

“So as soon as I bought the MRI and the MRI confirmed that there was this downside, you’ll have thought that it might have been a no brainer to only go forward and approve it. However the truth is, no, they need different issues finished first earlier than they’re going to approve an operation,” he mentioned. “I ended up going by bodily remedy, I ended up having a number of injections of steroids into my neck.”

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“It’s not splendid that we’re on this place the place, you realize, each sufferers and physicians are preventing with insurance coverage firms so as to get them to authorize care,” he added.

Whereas Dr. Cohen was capable of ultimately get the surgical procedure after three months, the expertise highlights points that many individuals have, as Dave prompt. As a result of if it took a health care provider that lengthy to get a obligatory process, what hope does somebody who’s not a health care provider have?

“Within the midst of my frustration, I used to be really saying the identical factor on a regular basis,” Dr. Cohen mentioned. “I imply, right here I’m a doctor and I no less than know what’s occurring and will clarify it and have, you realize, fairly direct entry to my surgeon. … The common individual actually is at a loss for with the ability to get issues finished in a well timed matter. And the issue is that you just’re then compelled to reside with discomfort, otherwise you’re compelled to reside with one thing that’s progressively getting worse.”

Hearken to Seattle’s Morning Information weekday mornings from 5 – 9 a.m. on KIRO Radio, 97.3 FM. Subscribe to the podcast here.


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