Spine surgeon Adam J. Bruggeman, M.D., M.H.A., one of a hand full of “must read” surgeon-bloggers, recently posted a dramatic piece on LinkedIn, calling out the deadly consequences of insurance companies who deny care and override multiple physician diagnostic and treatment recommendations.
“Prior authorization, a tool used by insurers to improve profits, is frustrating for all patients and physicians but is particularly dangerous in patients facing life-threatening diseases like cancer,” writes Dr. Bruggeman.
Dr. Bruggeman, a previous recipient of Becker’s Healthcare’s “Spine Surgeon Leadership Award,” references an article in his blog where the patient outcome was tragic. Tracy Pike, a 45-year-old father of three with Stage 4 stomach cancer, was denied the care recommended by his physician, namely, a combination of surgery and intensive chemotherapy. The insurance company’s peer reviewers disagreed with Pike’s physician team, calling the treatment “not medically necessary” because it was “experimental, investigational and unproven.”
Tracy Pike did not survive.
Dr. Bruggeman also points to a case where a required image to provide surveillance to look for metastatic disease in a patient with prior breast cancer was denied, being deemed “unnecessary.” The patient’s employer intervened paid for it directly, at which point it was determined that the previously denied surveillance scan had found new metastases that required intervention.
“Significant reform is needed to prevent profit from being prioritized over patients,” writes Dr. Bruggeman. “The stories in this NBC article are heartbreaking and reflect the real damage inflicted by faceless and nameless administrators and physicians, hiding behind computer screens and working to ensure that profits are maintained for shareholders at the largest insurers in the United States.”
Dr. Bruggeman, a spine surgeon in San Antonio, Texas, was one of 22 surgeons to win Becker’s Healthcare’s “Spine Surgeon Leadership Award” this year. This honor is given based on a nominee’s entrepreneurship, professional leadership, community leadership, and overall role in advancing the field.
