“Ninety-nine out of a hundred people” wouldn’t have fought the insurer, Powers said. “I just happen to be someone who is easily annoyed.”
Consumers aren’t the only ones annoyed by insurance company policies. Doctors say they are increasingly frustrated with insurers’ denying and delaying coverage of prescribed therapies, and sometimes even switching them. “You’re totally working within the constraints of the (insurance) plans,” said Dr. Lawrence Mieczkowki, a Kettering internist.
Dr. Darrell Lynn Grace of Dayton said her practice employs a full-time clerk “just to deal with pre-authorization” of therapies.
Insurance companies say they have medical directors and panels of physicians who set their therapy guidelines. In the case of Crestor, studies didn’t show until late 2008 that it was effective against heart attacks, said Anthem spokeswoman Kim Ashley.
Health care reform bills now in Congress would streamline procedures for pre-authorization of treatment, said Tim Maglione, a lobbyist for the Ohio State Medical Association. But he said insurers will have an incentive to interfere in patient care as long as profit remains an industry motive.
“Every time they pay a claim for covered services, they consider that a loss on their financial books,” he said.
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