Well, it has happened: Health Ins. companies "recommending" treatment plans to cut costs, outcomes be damned?

This is exactly what the story (linked below...) in the ultra-conservative Wall Street Journal on Tuesday, February 9, 2010 is talking about: Insurance companies (in this case, UnitedHealthcare) deciding who gets what (cancer) treatment - not the doctors, and certainly not the patient.

It's all based on what the insurance company costs are, not the health of the patient.

In the article, the insurance company sends "reports" to doctors and hospitals and "suggests methods" to "trim cancer treatment costs" - and to not necessarily follow the "medical protocol" for the type of cancer to be treated.


Read it and weep. We're already there: Insurance companies "suggesting" limited treatment plans. Insurance companies directing medical care. What if it was your mother, father, brother or sister or your husband or wife being required to take a substandard treatment regimen to save the insurance company money?

And, least we forget - we're all grown-ups here (supposedly). Try READING the article PRIOR TO COMMENTING.

Thanks kiddies...





Maybe this link will work better...



Update 2:

"INSURER PLAYS JUDGE ON CANCER CARE", by Avery Johnson 02-09-2010, WSJ

UnitedHealthcare, a unit of the nation's largest health insurer based on revenues, has started sending doctors individualized reports assessing their treatment of breast, lung and colorectal cancer patients. The reports show that while breast-cancer patients generally receive care that conforms to professional protocols, treatments given for colorectal and lung cancer tend to fail to meet expert recommendations more often.

Cancer is UnitedHealthcare's third-most-expensive disease, at a cost of $2.5 billion a year, after cardiovascular disease and orthopedic joint procedures. The company says its goal is not to rank or reward medical practitioners. Rather, it hopes that drawing doctors' attention to how their treatments might vary from medical protocol will reduce unnecessary care that doesn't improve health and raises health-care cost

Update 3:

UnitedHealthcare and other insurers have programs in place to track medical treatments that are easier to measure than cancer is. For example, WellPoint Inc., the country's largest insurer by number of members, has a pay-for-performance program in primary care that rewards physicians based on technology adoption and generic-drug use. But insurers have been slow to target cancer treatment and its costs, in part because of the disease's complexity and how it can affect patients so differently.

"Oncology has always been the third rail for managed care," says Lee Newcomer, Unitedhealthcare's senior vice president of oncology. "Insurance companies have been very reluctant to get involved in cancer care because any management might be perceived as denial."

Some critics say that monitoring quality is not the appropriate role for an insurer, which has a financial interest in all this. "This is one area I'd rather have doctors police themselves than have an insurance company do it," says Eric

Update 4:

says Eric Winer, chief scientific adviser for Susan G. Komen for the Cure, a research and educational organization.

The American Society of Clinical Oncology, a professional organization, has been running its own quality-assessment program, in which doctors' performances are measured against national guidelines. The group is seeking to enlist the help of insurers to expand the number of participating physicians. One company that has signed on is Blue Cross Blue Shield of Michigan, which pays doctors to help defray the administrative costs of submitting their clinical data to the program a few times a year.

Cancer-treatment quality has been particularly hard to track because claims information tells insurers relatively little about the patient. The data often don't make clear, for instance, if a breast-cancer patient is in remission or relapse. The differences in the disease's stage are uniquely important for cancer, since tumors change over time, necessitating different treatments.

Update 5:

So for the past three years, UnitedHealthcare has been collecting clinical information directly from oncologists. The company then compared the choices that a doctor made for a particular patient's treatment with claims data and guidelines developed by the National Comprehensive Cancer Network, a consortium of 21 leading treatment centers. In November, the company mailed the individual reports to 1,321 oncologists.

The company especially probed the use of high-price biotech drugs, which it says it found in some cases are being prescribed inappropriately. One NCCN guideline for colon-cancer patients advises that patients get chemotherapy after surgery, but in 31% of cases, the care did not comply with the rule. Instead, in the bulk of those cases, patients were prescribed Avastin, a Roche Holding AG biologic that is unproven in that patient group, says Dr. Newcomer. And among patients with non-small-cell lung cancer, about 24% received Avastin, even though their disease didn't meet the

13 Answers

  • Anonymous
    1 decade ago
    Favorite Answer

    Insurance companies have never put the health of the patient first. That's why for the last 10 years our premiums have risen while our coverage options have decreased.

  • Anonymous
    1 decade ago

    This has been going on for more than the past two decades. Where have you been? When my son was young, I took him to a doctor for a treatable minor infection and my health insurance carrier refused to pay for the treatment. They said it was unnecessary. Fortunately the cost was not prohibitive and I paid for the treatment myself. Insurance executives should be charged with practicing medicine without a license since they are determining what treatment a person should receive even though they are collecting insurance premiums that pay for health coverage.

  • 1 decade ago

    Partnerships between medical professionals and HMOs have been doing this for years; it is not standard health care, and is management of who gets what and who lives or dies.

    USA used to have world class health care, since the development of health care access programs however--each American is designated a set option of actual care.

    Americans need affordable health care, not access management through insurance companies or plans.

  • Anonymous
    1 decade ago

    I'm not surprised. Insurance companies have been requiring patients to notify them if they're hospitalized within a day or so or else risk losing benefits. They also say when a patient "should" be sent home. It's terrible that it's gotten to this.

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  • jdm
    Lv 6
    1 decade ago

    A) Page unavailable

    B) Where are all of the posts suggesting what the GOVERNMENT can do to cut costs? And do you know the basis or origination of this tactic by insurance companies? Did you assume that just one day, they decided to do this all on their own? It has nothing to do with government regulations, right? It's just the companies decided on their own?

  • Anonymous
    1 decade ago

    Unfortunately, it seem that about half of all Americans like this sort of arrangement.

    They feel that healthcare should be bought and sold like used cars and underwear.

    They foam at the mouth about government "involvement" but are comfortable with having a twenty five year old decide their fates when what is uppermost on his mind is that bonus and new motorcycle that he will earn while watching you die.

  • 1 decade ago

    And you think Obama care will be better in any way, except for a very small percentage of people, and will not be much worse for the majority?

    If so, you are deceived!

  • reading the article get back with you soon

    LOL Wall Street took the Article off, hmm I seee what you are saying!!!

  • 1 decade ago

    That's been happening for YEARS, and it's one of the principal arguments that the current system is messed up.

  • 1 decade ago

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