Posted : 09/16/2004
The relationship between doctors and health insurance companies can be a rocky one at that, and much of the tension stems from the hassles doctors encounter when it comes to HMO denials. The potential for HMO's to deny a request, coupled with the hassles surrounding the denial, have risen to the point of doctors actually misrepresenting their patients, just to get approval. If a patient's HMO denies their request, a doctor can appeal the decision, but the process to get a health insurance company to change their decision is a troublesome one.
Studies have shown doctors are more willing to lie about their patient's medical condition to get them approved when their case is considered severe, or when there is a high likelihood that an appeal will be denied. If the appeal has a higher probability rate for acceptance, doctors and physicians are less prone to stretch the truth when it comes to medical records and conditions. The more likely the HMO will deny coverage, the more likely a doctor will consider lying about the patient's condition.
The potential problem that may arise if a doctor lies to a health insurance company about a patient's medical condition is that the lie will also be reflected in the patient's medical records. A little white lie to the HMO company may seem innocent at the time; but the lie could wreak havoc if the patient switches doctors or develops a more serious illness. And while doctors think they are helping their patients through the HMO approval process, in reality, they could be setting them up to fall.
Many solutions have been suggested, but it really comes down to doctors and health insurance companies working together to control cost and provide access to the best health care for patients.
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