2 ms·

And this relates to the article how? Ultimate, what is described is an insurer tying to minimize the payout on a claim same as they have been doing from the da

And this relates to the article how? Ultimate, what is described is an insurer tying to minimize the payout on a claim same as they have been doing from the dawn of time except here it's particularly nasty as people suffer and die.

deleted 7y ago
[deleted]
Scoundreller 7y ago
The beef in the article seems to be "We're not paying for it, because it's not in our guidelines" vs. "Doctor thinks this patient is more special than the guidelines" Where in the article says that the insurance provider was trying to minimize the payout on the claim? Insurance companies really hate paying for things that don't work (or have a low likelihood of working). Even more than paying for something expensive that works. The article is really annoying, because Treatment A didn't work, and they wanted to skip Tx B and go right to Tx C. Tx C worked, but the article never named any of the drugs, so we can't evaluate the validity of this guideline. We just have one anecdote of one event where doctor was ultimately right (because nobody runs to the LA Times when they were in-the-wrong).
- sorokod 7y ago
  > "“So we get a phone call here to my staff saying that the pharmacist – not the doctor, but the pharmacist – to the PBM called and said they are denying the drug.” The reason given: The patient should have surgery to remove his kidney first."
  - Scoundreller 7y ago
    Notice that the doctor didn't disagree with that being a course of treatment for this disease. Their response was that the patient was too ill for that surgery - a detail that wasn't known to the PBM. Either the issue is: 1) Kidney removal shouldn't be a course of treatment (unknown based on the details provided). Keep in mind, the same insurer would be paying for this, and it isn't cheap, so it's not as ridiculous as it sounds. 2) Patient status with regards to surgery wasn't communicated to the payor, but should be a part of that process. Or it was a part of the process, but it was omitted. 3) Kidney removal should be a course of treatment, but the doctors didn't want to go through with it anyway, and made up some reason after-the-fact to continue to support their beliefs.
    - illumin8 7y ago
      > Notice that the doctor didn't disagree with that being a course of treatment for this disease. Yes, but having a PBM tell a doctor that their diagnosis is wrong and try to change their professional recommendation, without ever having seen the patient, and with unknown qualifications, is downright evil and probably malpractice. We have doctors for a reason. They took a hippocratic oath to do no harm, and allowing unqualified people who took no such oath to tell someone to "just take out the kidney" is abhorrent.
      - DanBC 7y ago
        You place a lot of trust in doctors. Knee arthroscopy is a good example where doctors knew for a fact that they were helping patients until we ran trials using sham surgery and we found out it doesn't help some patients at all. https://www.painscience.com/biblio/fascinating-landmark-study-of-placebo-surgery-for-knee-osteoarthritis.html https://www.painscience.com/biblio/fascinating-landmark-stud... https://doctorskeptic.blogspot.com/2012/08/placebo-surgery-4-knee-arthroscopy-in.html https://doctorskeptic.blogspot.com/2012/08/placebo-surgery-4... PBMs are probably bad, but we need some organisation to look at the evidence and say whether something works or not.
      - Scoundreller 7y ago
        > They took a hippocratic oath Not as common as you think.
  - Scoundreller 7y ago
    Also not understanding the doctor's disdain for a pharmacist calling about when to use or not use a medication. That's what they do...

deleted 7y ago

[deleted]

Scoundreller 7y ago

The beef in the article seems to be "We're not paying for it, because it's not in our guidelines" vs. "Doctor thinks this patient is more special than the guidelines" Where in the article says that the insurance provider was trying to minimize the payout on the claim? Insurance companies really hate paying for things that don't work (or have a low likelihood of working). Even more than paying for something expensive that works. The article is really annoying, because Treatment A didn't work, and they wanted to skip Tx B and go right to Tx C. Tx C worked, but the article never named any of the drugs, so we can't evaluate the validity of this guideline. We just have one anecdote of one event where doctor was ultimately right (because nobody runs to the LA Times when they were in-the-wrong).

sorokod 7y ago
> "“So we get a phone call here to my staff saying that the pharmacist – not the doctor, but the pharmacist – to the PBM called and said they are denying the drug.” The reason given: The patient should have surgery to remove his kidney first."
- Scoundreller 7y ago
  Notice that the doctor didn't disagree with that being a course of treatment for this disease. Their response was that the patient was too ill for that surgery - a detail that wasn't known to the PBM. Either the issue is: 1) Kidney removal shouldn't be a course of treatment (unknown based on the details provided). Keep in mind, the same insurer would be paying for this, and it isn't cheap, so it's not as ridiculous as it sounds. 2) Patient status with regards to surgery wasn't communicated to the payor, but should be a part of that process. Or it was a part of the process, but it was omitted. 3) Kidney removal should be a course of treatment, but the doctors didn't want to go through with it anyway, and made up some reason after-the-fact to continue to support their beliefs.
  - illumin8 7y ago
    > Notice that the doctor didn't disagree with that being a course of treatment for this disease. Yes, but having a PBM tell a doctor that their diagnosis is wrong and try to change their professional recommendation, without ever having seen the patient, and with unknown qualifications, is downright evil and probably malpractice. We have doctors for a reason. They took a hippocratic oath to do no harm, and allowing unqualified people who took no such oath to tell someone to "just take out the kidney" is abhorrent.
    - DanBC 7y ago
      You place a lot of trust in doctors. Knee arthroscopy is a good example where doctors knew for a fact that they were helping patients until we ran trials using sham surgery and we found out it doesn't help some patients at all. https://www.painscience.com/biblio/fascinating-landmark-study-of-placebo-surgery-for-knee-osteoarthritis.html https://www.painscience.com/biblio/fascinating-landmark-stud... https://doctorskeptic.blogspot.com/2012/08/placebo-surgery-4-knee-arthroscopy-in.html https://doctorskeptic.blogspot.com/2012/08/placebo-surgery-4... PBMs are probably bad, but we need some organisation to look at the evidence and say whether something works or not.
    - Scoundreller 7y ago
      > They took a hippocratic oath Not as common as you think.
- Scoundreller 7y ago
  Also not understanding the doctor's disdain for a pharmacist calling about when to use or not use a medication. That's what they do...