wherein mike_c rants about health insurance shortcomings....
Twice in the past year my insurance company-- one of the biggest in California-- has dictated my cardiac care to my cardiologist, despite his objections.
The back story: Just over a year ago I became a common statistic of aging and went into atrial fibrillation. A-fib isn't particularly uncomfortable, or at least it wasn't for me, but there is significant risk of throwing a clot and having a heart attack or stroke, so it needs to be dealt with. I underwent a successful cardioversion last June, and have had normal heart rhythm since.
For several months before the procedure I was on anticoagulants to reduce the risk of stroke. That was the first time the insurance company intervened. My doctor prescribed a drug whose name I don't recall, but when I arrived at the pharmacy they told me the insurance company had refused to cover it because there was a less expensive drug available. The less expensive alternative was warfarin, of course. The difference between the drug my cardio guy prescribed and warfarin is vast. The prescribed drug is not nearly so dose dependent, so it doesn't require constant monitoring, and it's much easier to tolerate. Warfarin requires frequent-- at least weekly-- blood tests to prevent bleeding. I don't tolerate warfarin well, and went through several months of hell. Unbelievable bruises that literally wept blood. I pissed blood-- not just a little blood in my urine, but let me tell my brothers that when arterial red blood streams from your penis, it gets your attention fast. A week after the procedure the cardiologist took me off warfarin, saying that my risk of bleeding out was greater than my risk of complications from the a-fib. But the insurance company would not relent.
Today I was scheduled for another follow up appointment-- my cardiologist had ordered an echo-cardiogram, cardiac ultrasound imaging-- to see whether my atria had been damaged and just to get a general look at my ticker. Yesterday the office called to cancel. My insurance company had denied permission for the procedure-- that's the precise phrase used to explain this-- because there are less expensive diagnostic procedures available, presumably a stethoscope and an EKG, neither of which let the doctor directly observe a beating heart. He expressed considerable frustration about that.
So it seems that my cardiac care is ultimately being directed by the profit management division of my insurance company, with the primary goal being to control my access to medical care in order to maximize their profits.
This is not a rant about Obamacare, which has nothing to do, at least not directly, with these events. It's about my anger that my cardiologist must seek approval from some cubicle dweller with a bachelor's degree in oral communication or some such thing and a manual of "no's" before applying his best medical judgement to my cardiac care. Have you noticed that physicians or doctors-- both terms that imply lengthy education, experience, and considerable knowledge-- have become simply "providers" in the parlance of modern American health care? They are increasingly regarded simply as the patient contact wing of the health insurance industry.
/rant
= new reply since forum marked as read
In the world.
And your doctor is right to be frustrated. Yes, in general we luuuvvvee the toys, but the companies should not say what treatment is proper.
instead of your doctor. 
