How Capital Region physicians are pushing against insurance treatment limits

Capital Region physicians and other health care providers say they must navigate a landscape that is increasingly cumbersome, requiring more prior authorizations and additional layers of bureaucracy to defend treatments they deem beneficial.

As Business Report writes in its latest issue, while large advocacy groups like the American Medical Association have lobbied for streamlining authorizations and better transparency from insurance companies, Capital Region doctors say achieving patient-centered care in an environment where insurance companies hold the cards is a daily challenge.

Dr. Craig Greene, an orthopedic surgeon with the Baton Rouge Orthopaedic Clinic, says the shift to evidence-based health care, which theoretically cuts down on fraud and overbilling, has taken control away from health care experts.

“There’s been a progression throughout health care of evidence-based medicine, and that’s been, in large part, very good for patients,” Greene says. “But it has shifted all the power from the patients, and the decision-making authority from the doctors, over to the insurance companies.”

Insurers base their coverage decisions on aggregated medical studies, Greene says. But these strategies, including step therapy, or “fail first,” policies, can be time-consuming and counterproductive.

Read the full story, and send comments to editor@businessreport.com.