Insurance Companies Practicing Medicine Without a License?

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By Macro Analyst Desk

Did you know that insurance companies can hinder doctors and nurses from doing their jobs? If a patient needs a medical test done or some other type of intervention, insurance companies more often than not will say no to coverage if they deem it unnecessary in their eyes. By making a doctor jump through hoops, questioning the doctor’s expertise and judgment, and denying care altogether, some may even say that insurance companies are practicing medicine without a license.

Why should insurance companies get a say in what tests or treatment a patient receives when they have not been through medical school or residency? The health insurance industry prides themselves on putting profits over patients, and have reported on earning net profits last year upwards of $18 billion. To insurance companies, it is highly profitable to make physicians jump through hoops to get coverage. Physicians find themselves having to put in prior authorization requests before prescribing medicine, or even advocating for their patients when their insurance company suddenly no longer covers the prescribed medication or treatment. And in many instances, physicians are required to go for the cheapest treatment plan first, even if it may not be the most efficient one.

By putting these roadblocks on doctors, insurance companies are playing the long game. They are hoping that both physicians and patients will get too busy and burnt out to advocate for themselves, or they will take the path of least resistance by choosing the cheapest option. Health insurance is a multi billion dollar industry and the burden it places on doctors is a large reason why. Although society sees health insurance as necessary, because they give just enough coverage to avoid bankruptcy for the general public, we often ignore the struggle and battles our doctors are fighting behind the scenes.

If that sounds exhausting, imagine how doctors feel. “Insurance companies often create roadblocks in healthcare by second-guessing the medical judgment of physicians,” says Dr. Gail Gazelle, MD, venerated physician coach and Assistant Professor of Medicine at Harvard Medical School. “This stems from their desire to control costs, but it can also lead to delays in essential tests and treatments, ultimately compromising patient care.” 

These interventions are not just a simple stroke to the ego for doctors. In fact, every minute a doctor spends fighting with an insurance company is a minute they could be spending treating patients, learning about new medical advancements, or searching for a difficult diagnosis. Health and time are vastly interwoven in our lives, making time a valuable resource to healthcare workers. If doctors are too busy fighting a profit-centered battle they didn’t sign up for the doctors won’t be the ones suffering – it will be the patients.

These roadblocks not only hinder timely medical interventions but also strain the doctor-patient relationship. Additionally, they create a high level of stress and work for the physician, taking away from the time the physician has to actually provide the care their patients need,” says Dr. Gail Gazelle, MD/

This amount of strain can also lead to burnout in doctors. A topic Gail discusses in detail in her book “Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout.” If doctors become too burnt out from fighting battles they cannot win, or jumping through hoops that inevitably hurt their patients, then they could give up on the medical field altogether. We should be able to entrust our doctors, who have gone through years of schooling and training, to be able to care for our patients, and we should entrust their knowledge and expertise with the time they need to perform their jobs.

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