Posted on 06/11/2006 5:33:25 AM PDT by Jim Noble
FRAMINGHAM -- When Tufts Health Plan cut a patient's prescription for the sleep aid Lunesta from 30 pills to 10 pills a month, her physician, Dr. Stephen A. Hoffmann, decided to circumvent state regulations by writing a second prescription in the name of her husband so she could get 10 more pills per month .
Hoffmann is aware that by publicly acknowledging the prescription ploy, he could be subject to disciplinary action and ... criminal charges. But he considers himself a ``medical conscientious objector," and says patient's welfare comes before what he believes are unreasonable insurance restrictions...
But the head of the Massachusetts Board of Registration in Medicine , the licensing authority for the state's physicians, said writing a prescription for someone other than a patient constitutes insurance fraud and violates the board's prescribing rules. Hoffmann could face a range of sanctions, from warnings to fines to license revocation...
With regard to insurance company restrictions, he said, ``It's becoming increasingly clear to me that the system is badly broken. A lot of my colleagues are demoralized, angry, and frustrated. Rather than . . . moan over late-night coffee in the corridors of the hospital, it's time to convert our dedication to our patients into a more constructive stance."...
But another ethicist, George Annas, said Hoffmann has an obligation to work within the boundaries of the law. ``He's not the only frustrated doctor in Massachusetts," said Annas, who is chairman of the department of health law, bioethics, and human rights at the Boston University School of Public Health ...
Hoffmann said that he understands that insurance companies and hospitals are trying to rein in a healthcare system bloated by runaway costs, but that he is responsible for providing the best care he can, not helping to restrain spending by insurance companies...
(Excerpt) Read more at boston.com ...
To start the ball rolling, any patient who does not want to abide by their contract with their insurance company is free to pony up the money for whatever it is they want.
The insurance companies have had great success in making doctors feel responsible for what they will pay for, when in fact doctors have nothing to do with it.
If Dr. Hoffman were to appeal every adverse insurance determination in a 2500-person practice, he would need to work at it 7 days a week and do nothing else.
Is that a good idea?
ping
What would happen in physicians got together and defied the insurance companies? The insurance companies need the docs not the other way around.
Insurance is the patient's problem.
If somethings isn't covered, one can still have it but pay for it.
THe Dr. is wrong here. Let the pt take the problem up with the insurer.
I am tired of hearinig people whine they cannot have something because insurance "won't cover it". You can have what you pay for. When did people decide that insurance was supposed to pay for everything.
The insurance company does not control the amount of medicine a doctor may prescribe. All it does is to announce the amount it will pay for.
Wyh didn't the doc give the pt a separate rx that she paid for out of pocket or is this not allowed.
The problem is that insurance companies don't want to pay for ANYTHING.They are more than happy to raise their rates and reduce care,all from corporate headquarters whose opulence rivals a King's palace.
Required to work within the boundary of the laws. Not when the laws were made in secret and by someone(s)with an entirely different agenda than to help a patient as this doctor is.
Also, maybe the doctors could make their prices fit their patients; then there would be no need for insurance companies.
Unfortunately, not as long as scum bag lawyers like John Edwards walk the earth.
I think doctors are as much to blame as anyone in this entire medical mess. My wife and I have 5 children and between them and ourselves we have a 21 year history of Doc visits. Some years we've had insurance and sometimes we didn't. My first two sons were paid out of pocket at roughly 1800 a piece in 86 and 87. The 3rd in 89 was paid by Fed Ex company insurance and my 20% was about $900.00. So they charged my company about 4500.00 We have seen this over and over in varied medical and dental situations between being un-insured and insured.
Just my two cents.
Health insurance (like just about ALL other insurance) should be purchased and paid for by individuals, NOT employers. I have the options of hundreds of car insurance companies and thousands of plans. I have the options of hundreds of homeowners insurance companies and thousands of plans. I have the option of hundreds of life insurance companies and thousands of plans. I, basically, have the option of ONE health insurance company and ONE plan that my company pays for WITH MY MONEY!. I can go outside what my company offers, but they would pay me pennies on the dollar of what they pay for the insurance and I would lose the pre-tax insurance benefit.
Absolutely correct. The insurance companies provide nothing but an expensive layer of bureaucracy between the patient and the physician ... shuffling papers, denying claims, rolling in the premiums and trickling out the benefits.
Unfortunately the medical profession is a loose knit organization lacking a binding authority (such as the upper echelon insurance company execs) who can make policy that would defy the insurance companies. There would always be those physicians who would get away with not complying.
Therefore physicians and patients will always remain at the mercy of the insurance companies until the government takes over to "fix" it, and then, of course, we are all scr*wed.
I agree with you.
where is it stated that "insurance' should cover everything? Or the government shoudl cover it.
Who do people think "insurance" or the "government " is?
the money to pay for this care comes out of ins premiums, or govt taxes, or employer benefits...which we all end up paying for in one way or another.
The Dr is wrong. If the patients don't like the system they can change it, or pay the difference.
Extra 10 Lunesta pills: ~$37/month.
If she really needs to take a pill to sleep every night something is wrong.
"I'm interested in FReeper perspectives."
I hate insurance companies in general. Medical insurance companies are probably the worst. If I pay cash for a doctor visit I pay $79-$99. With insurance I pay $20 copay and then the insurance company pays about $19 for the same visit. Thats after a lot of paperwork.
Seems to me that if doc's could give us the $39 fee for cash we wouldn't need insurance for everyday visits. It would also save them a ton of paperwork. Sounds like Im against doc's but im not. Just the system the insurance companies have created.
"If she really needs to take a pill to sleep every night something is wrong"
Thats the american way though. Take a pill and relieve the symptom.
I also deal with this problem every day in practice. The doctor is committing insurance fraud. Insurance formulary prescriptions are a pain in the butt, but they exist for a reason. Insurers are struggling to control spiralling drug costs. Costs will only be controlled when the patient has some financial incentive to help control costs. The current system doesn't work. The employer buys insurance for patient, patient sees doctor, doctor prescribes drug, insurer says drug is too expensive. Those closest to the drug purchase have no financial incentive to control costs.
And this is Lunesta - it's a sleeping pill, not a livesaving drug. The patient is free to buy the extra 20 pills a month out of his pocket. If more people did so, the cost of the drug would come down.
Bingo. The doctor committed fraud. Its not his business whether or not the insurance company will pay. This is no different than an auto body shop stating that work was done on two vehicles in stead of one in order to decrease the cost for the customer by increasing the insurance companies obligation.
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