Local doctors: Insurance companies are making medical care more difficult

Posted

Several doctors at Long Island Jewish Valley Stream say that their ability to provide patients with the best health care has been hindered over the past few years by insurance companies.

Dr. Gus Katsigiorgis, an orthopedic surgeon at the hospital, said that his office spends a lot of time — time that could be used treating patients — trying to authorize tests that would help him diagnose patients. “A lot of what we do requires authorization,” he said.

To make matters worse, Katsigiorgis said, each insurance company has a different processes for authorization. “Certain insurance companies require an office note, some require a physician call,” he said. “My office will often stay on hold for 15 minutes, and then they pick up and say, ‘Oh, we need the doctor’s note.’”

The hospital’s psychiatric unit has problems getting insurance companies to approve prescription medications. According to Dr. Stacy Yearwood, the chair of psychiatry, an insurer can take several weeks to authorize a patient’s use of a prescription after he or she leaves the hospital, and rehabilitation coverage may be denied as well. “If the patient is no longer saying they’re suicidal,” Yearwood explained, “[insurers] will have a problem with continued payment.”

The problems with insurance companies, the doctors say, have only gotten worse over the past few years. Although more patients have health insurance under the Affordable Care Act, or Obamacare, the quality of coverage, they say, has declined.

According to Dr. Kunjurman Chandramohan, an emergency room doctor, Obamacare gave patients the confidence that they had health insurance, without improving the quality of that insurance. “It’s like putting lipstick on the whole Medicaid program,” he said.

Katsigiorgis went even further, saying that although more people have health insurance, the deductibles on their plans have increased, which discourages patients from getting the care they need. To illustrate his point, Katsigiorgis recalled a young, athletic patient he saw with a torn Achilles tendon. Surgery was too costly for the patient, so he opted for non-surgical care, which does not heal the tendon as well.

Katsigiorgis added, however, that he was grateful that more people have some form of health insurance under the Affordable Care Act. He said that it is difficult to provide treatment for a patient who is uninsured. “If the patient has no health insurance,” he said, “you can’t do anything with them, because you can’t get any tests authorized.”

But even with more insured patients, the doctors agree that it is becoming increasingly difficult to get tests and drugs authorized, as insurance companies continue to wield power over doctors’ decisions. “I’m not saying there shouldn’t be checks and balances in medicine,” Yearwood said. “I’m just saying it shouldn’t be challenged as much.”