ObamaCare on the Front Lines: Insurance Company Seeks to Deny Care with Government Power. Meet the B.M.!

Last month I saw a patient who had a spinal tumor (recall I am a brain and spine surgeon).  This small mass had a chance of growing and causing paralysis.  We had a long discussion and determined that it was likely benign, but she had not had the proper MRI done to evaluate the tumor and it was also important to see if it was growing on the MRI.  So, like a good doctor serving my patient, I ordered another MRI of her spine.  What happened next is becoming common place although it is a new phenomenon based entirely on the enormous rationing powers the government has placed in the hands of insurance companies through ObamaCare.  The insurance company worked to deny the MRI to the patient and thus put her life in danger.  I had to spend a half an hour of uncompensated time and pay my staff for more time to dispense with this and get her the test she needed.  (continued below….)


NIAMeet the BM company, the “Benefit Managers”.  This is not the good kind of BM but the kind that actually interferes in getting you the test you paid for when you bought your insurance.  Under Obamacare, they have grown in prevalance and use as the insurance companies have government power to ration handed to them.


What happened?  The 30,000 foot picture is that the affordable care act is mandating that every one buy insurance.  It is also creating limited budgets for each patient’s “episode of care” and sets up a system where the insurance companies will make more money by denying care.  It is taking away the choice from patients to have the tests they need. It is penalizing doctors financially and through hassles like this so the doctors will happily comply with the rationing regime, throw their hands up and say to the patient “sorry, there was nothing I could do about it”.  What they forgot is that there is still a group of doctors, a shrinking group for sure, that will NOT forget about it and will advocate for their patient. They are quitting however because they know they will have to pay to work before long and they would rather sell hot dogs on the roadside than compromise their moral obligation to the patient. 

The actual facts look like this.  The doctor (me), a board certified neurological surgeon practicing for 14 years, orders an MRI on his patient with a spinal tumor.  I have spent 45 minutes with the patient and spoken to her about her desires and her concerns.  The test then goes to the insurance company where something new is happening: the advent of the “Radiology Benefit Manager” (RBM, or “BM” for short).  The insurance company gets the prescription and sends it to the BM company for review.  The BM company has a doctor they hire.  In this case it is a doctor with no Florida License who is a retired general surgeon (not a neurosurgeon), although it could just as easily be a pediatrician (this has happened) and one day will be a nurse and later will be a high school dropout following computer prompts.  The BM company then makes a call to my office staff.  My staff, working in a very tight operation to keep overhead down, takes time away from patients to pull the chart, send records and communicate by FAX.  The BM company then calls my office and demands that I call their BM doctor (the Chicago based retired non-neurosurgeon) to have a “peer to peer” review.  In this case the doctor says: “So what can I do for you”? I respond “For me? You called me!  What do you want”. It becomes clear that the doctor has NOT EVEN READ MY HIGHLY DETAILED MEDICAL NOTE ON WHY I ORDERED THE TEST IN THE FIRST PLACE.  We have a conversation and I give him not one bit of any information. I ask him to simply read the note while I sit on the phone.  He says: “Oh. This is fine.  Please write down this authorization number”.  Elapsed time for me, about 30 minutes.  In that time, I could have seen two follow up patients.  For my services and time, I am paid zero dollars while I lose money all for the opportunity to speak to an uninformed, unqualified, unlicensed “doctor” who has the power to “recommend” to the insurance company that the test not be performed.   Of course, the insurance company has good lawyers, so he just “recommends” and avoids the part where he is actually held to account for practicing medicine without a license.   

Patient can expect more of this “managed care on steroids” from their insurance companies under Obamacare. They will have the power to force you to buy their product. The government will defend their right to engage in these “efficiency” activities because they have the power to define what insurance is.  If you want good medical care, you need to stop this. If you want choice in insurance and you want the benefits you paid for, you need to stop Obamacare. Only the patients can stop it. The AMA will support it along with all the special interests. The bad doctors will “go along to get along” while others sell out to groups like the Obama-created “Doctors for America”.  The good doctors can’t stop it, but you may be able to buy a good hot dog “all the way” from them on your local street corner.

If you want to help stopping Obamacare, join groups and efforts like this: “Hands off My healthcare” and the Doctor Patient Medical Alliance . Listen to this doctor group for cues and information: Association of American Physicians and Surgeons and look at this patient empowerment health reform plan from the Florida Medical Association.  


10 Replies:

  1. DOnna Beach

    Dr. McKalip:
    I am a parisher of “Sacred Heart” in Pinellas Pk and how do I find out if it is involved with “FAST”? I have not heard any radical ideas from the pulpit.

  2. Dr. David McKalip

    Please read my posting on this site about FAST.  I bet however that you are hearing calls to join FAST.  I bet they are taking from the offertory.

  3. Theresa Capricci

    Dr. McKalip,
    Just learned of you today while listening to Glenn Beck’s radio show. Over a year ago we moved from Harrisburg, PA, to Palm Harbor. We have been searching for a Catholic Church that is really a Catholic Church. We hear about FAST – which my husband said right away–this is not what the church should be involed in. In addition to this, people are holding hands during the Lord’s Prayer (even with Rome saying this is not correct – it still goes on). Is there any Catholic Church in this county that is really a Catholic Church????

  4. Helen Russo

    This is happening in more than the medical field. It is a rip off, a con job to actually extract more money from anywhere these mega-corps/government can-our county hired and out of county firm to do code checks. It was a nightmare and cost money and jobs across the industry. We feared we’d loose our business as did all the other folks involved in the building industry including architects, planners, contractors, tilers down to the part time office staff. This is and was a nightmare.

  5. Benadette L.

    I have have had the experience of elderly patients being told that they do not have a fracture after serious falls because the x-ray says so. After very painful physical therapy sessions, they are finally given an MRI only to find that they did indeed suffer from a fracture! Thank you for this blog! I now know that Hawaii isn’t the only one already practicing Obamacare!

  6. MIke

    Doc – Our family doc of 7 years, a young guy in a large practice in Connecticut, quit the practice to become what he called a concierge doctor. To charge $3000-$4000 a year to a select number of patients for complete access to him, without insurance hassles. He said most doctor visits are routine and routine visits should not cost what it does to patients (or insurance companies) nor should routine visits overwhelm a large practice and overtax doctors working there. Without all the overhead and time commitment, he figured he needed 60-80 families and had I not had work insurance I would have signed up. Then all one needed was a small policy to cover hospital lab and any catastrophe, with a large deductible. As long as he maintained privileges at the large local hospital he could still order tests, etc. Now that we are closer to retirement, that is the route we are going to take.

  7. Theresa Capricci

    This is a great idea. However, it is very hard, ir not impossible, to find a health insurance policy that covers major items as you describe. When I sold health insurance, there were people who were interested in those and they weren’t available.

  8. David McKAlip

    Actually Theresa, the high deducible health plan would be a good option. AFter meeting the deductible (from a tax free health savings account) the plan covers 100% of medical care. I have one and my premium for a family of five is about $5,000 per year!

  9. Keith Newport

    God bless you for exposing the tragedy that will engulf our country if people don’t make informed decisions. God bless our founders for crafting the miracle that is our constitution. Thank you for exercising your precious right to speak freely and point to the dead-end trail the socialists in power are trying to force us down. We must all pray for an awakening of the American spirit so that we can exercise our right to vote the evil of socialism out and the freedom envisioned by our founders back in. Obamacare is just the ‘nudge’ toward serfdom.

  10. Theresa Capricci

    Will you be able to have this plan when ObamaCare becomes effective???


Comments are closed.