Letters

letters | jumping through hoops to get right medication

Doctors must stand firm against insurers’ attempts to control treatment

Insurance companies have no right to practice medicine without a license. An operator telling a patient, “You need to try another drug,” is just that (“ ‘Fail first’ fails patients,” Op-ed, April 6).

In the face of Evan Hempel’s insurer’s bureaucracy, a “supportive doctor” helped Hempel get a supply of the antidepressant he needed. Such supportive doctors are necessary, however, only if we continue to allow insurers to dictate treatments.

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I am, I hope, a supportive doctor, but I refuse to participate in the “prior authorization” process, which is the means by which insurance companies exercise too much control over my practice. I simply tell them that if they do not approve medication I prescribe, I will help the patient sue them. This has worked 15 times in a row.

Insurers should pay for medically necessary treatment. But they have no right to dictate that treatment.

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It is time for doctors and patients to unite to put insurers where they belong: paying bills for medically necessary treatments.

If, after the fact, an insurer wishes to review with me my prescribing habits, I would be very happy to participate. But not as of now, at patients’ expense, before treatment is initiated.

This is not just about brand-name drugs; it applies to pill counts and generic medications. The prior-authorization process is a cancer that is spreading.

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Doctors must stop the process altogether, rather than try to solve the problem a case at a time.

Dr. George Sigel

Boston

The writer is a clinical professor of psychiatry at Tufts Medical Center.

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