There is a certain specialty doctor that I have heard my other doctors complain about. They call they the “Sell Out” doctors. These are doctors that leave their practice to work for an insurance company.
What’s their job there? Do they examine employees of the insurance company at the nurse’s office? Are insurance companies so wealthy that they keep doctors on staff to examine their employees, thus keeping insurance costs down for themselves? Nope. These doctors, some actual specialist like cardiologist and Pulmonologist actually are hired by insurance companies so you don’t get paid. Their sole purpose is to find a way to deny an expensive claim or pre-approval.
When the insurance company says that the pre-approval or claim is under review, the people reviewing it are actual doctors, and they, without seeing you or examining you, decide whether or not to accept a claim.
I am going through that right now for a prescription of a steroid inhaler. The insurance company did not approve it and wants me to instead take a much cheaper inhaler. The inhaler that was prescribed costs around $250.00. The one they want me to take costs around $50.00.
There is a specific reason the one my doctor wants me to take was prescribed. It does not affect the heart. Most inhalers contain medication that increases the heart rate.
Yet, someone who went to medical school and took an oath to protect lives is now protecting the insurance company’s bottom line. Sad to be a sell out.
Originally Posted June 2012