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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.

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.

I simply tell insurers that if they do not approve medication I prescribe, I will help the patient sue them. This has worked 15 times in a row.

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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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