Michael Cloney, MD, MPH

American Physician Assistant who has worked in cardiology for 8 years says “I have NEVER seen so many echos denied like I have this year” She says health insurance companies are denying routine scans at rates like never before and making it harder to appeal. Just this one phone call she spent 41 minutes of her lunch trying to get approved through the prior authorization department This video shows how many runarounds and multiple numbers and transfers the insurance companies make doctors offices go through, making it literally impossible to get things approved Health insurance companies just keep getting worse and worse

Almost anyone can own a hospital ... except a physician.

There is no algorithm that can replace the instincts of an experienced physician when faced with a patient in need. When the doctor who saw this patient in the Emergency Room examined her, spoke with her, and decided to admit her, I know that he did so because he knew best how to keep her safe. I am grateful. I am disturbed that her insurance company questioned that judgement and presumes to know better than the doctor in front of her. The following statement in the denial letter says so much about the current state of healthcare: “When a doctor or facility treats a patient above the recommended level of care, we cannot cover it.” This does not pass the sister test. I’ll take the best judgement of the doctor who was physically present at the bedside of a frightened patient over an insurance company’s algorithm every time. And I refuse to accept that this is the best we as a society can do.