Medical Insurers
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The article centered on the dilemma of the insurance industry and the physician (and) creates the ludicrous illusion that the physician makes long and fruitless efforts to obtain the approval of the insurer or governmental agency for his proposed treatments. In every other setting than hospital or surgical, this is simply not the case. He proceeds with his intended tests and treatments and bills both the patient and the insurer. If the insurer or governmental agency disapproves the charge, the bill is then continued in full amount to the patient.
Virtually every patient is made aware by the physician’s staff is that he is “always responsible” for the physician’s charges. This intimidation usually works very well, especially with the elderly Social Security patient on a borderline poverty level.
A fair portrayal of “utilization review” is that it is focused almost totally for the benefit of the insurance industry.
JANE M. TERRY
North Hollywood
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