Doctors who have paid millions of dollars to settle multiple malpractice cases may be making crucial decisions about your health care. They may have repeatedly botched urology surgeries and left their patients incontinent; they may have performed faulty hip replacement surgeries that left their patients with a permanent limp and chronic pain; they may have administered anesthesia incorrectly, leaving their patients with permanent brain damage; or they may have committed any number of horrific mistakes that permanently injured their patients and still get hired by health insurance companies as medical directors in charge of authorizing or denying coverage for your health care.
This highly disturbing information was recently reported by ProPublica, an independent, nonprofit newsroom that produces journalism in the public interest. According to the report, despite multiple, large settlements for medical malpractice cases and, in some cases, disciplinary actions by state medical boards, doctors are working as gatekeepers of patient care for insurance companies such as Aetna, Cigna and UnitedHealthcare.
Without ever examining or talking to patients or their physicians, these doctors have the power to overrule the judgment of the patients’ doctors and make life-altering decisions about what treatments and procedures are medically necessary. In many cases, these insurance company medical directors are distinctly unqualified for overseeing the health care decisions for which they are responsible. For example, an anesthesiologist or pediatrician might overrule a patient’s cardiologist; an orthopedic surgeon might rule on a procedure needed to treat arrhythmia; or an oncologist who hasn’t practiced in the field for more than twenty years might deny coverage for a new, effective treatment for cancer.
Unfortunately, these doctors “crank out denials” with impunity. Patients’ doctors can, of course, refute an insurance company medical director’s decision during a peer-to-peer review, but they have been repeatedly frustrated by the medical directors’ lack of expertise. Insurance companies, however, stand by their medical directors’ decisions and claim they use evidence-based guidelines and patients’ medical records to make decisions about what is medically necessary.
Medical Malpractice and Health Insurance Company Medical Directors Hurt Vulnerable Patients
As a Miami personal injury and medical malpractice attorney who has dedicated his entire legal career to seeking justice for victims of other’s negligence and who has won many multi-million dollar recoveries for victims of serious accidents and medical malpractice, the thought of these unqualified, very likely negligent doctors making crucial decisions about patients’ health care is extremely disheartening and frightening. Medical malpractice “frequent flyers” need to be held accountable for their repeated mistakes and negligence with not only legal claims brought against them by injured patients, but also disciplinary actions by state medical boards and employment decisions by all health care entities, including insurance companies.
The bottom line is that we should not be allowing doctors who have repeatedly injured patients through their ineptitude and negligence to be making life-altering decisions about insurance coverage for patients’ treatments and procedures. They have done more than enough damage and should not be allowed to continue making health care decisions that hurt vulnerable patients.