In this article from Becker’s Spine Review, the subject is the most dangerous trends in ortho and spine from 25 leaders, and the majority of the opinions regard loss of control of physicians over the process of patient care.
While physicians are becoming increasingly burned out fighting the obstacles to care placed by payors, and the end of the day, the biggest losers will be patients
Though not medically related, this article from March ’23 shows more examples of insurance company bad behavior, that typically goes unregulated and unchecked. I see these bad faith actions all the time in medical coverage, and even have some documented about Ambetter, an insurance provider in GA, that can be seen by clicking here. 
The issues outlined in this WP article discusses claims made by homeowners who had severe home damage to their home during Hurricane Ian in Florida.
The link to the article is here, but if you don’t want to read it, here’s the summary version:
Even though adjustors made certain assessments, the insurers hired other adjustors to change the assessments with a new result that…Surprise!!!…involved no payout for the claims.
For folks who buy insurance, who actually think they have insurance, the guarantee is not of coverage, but only of the insurance company making profits.
So, here’s how the conversation goes:
Patient: I have this and that problem.
Me: Well, we’ve discussed normal anatomy, what is going on in your situation, and why you have your problem, and also the treatment options. You can do A, B, C, and even D (often: surgery).
Patient: Well, what do you suggest? [Editorial opinion: reasonable question. I mean, you are the doctor!!]
Me: I would be asking the same question if our roles were reversed, but whatever I suggest, you (the patient) would have to agree.
Here’s the deal: In my experience, most patients have enough pain or other symptom to make an appointment and decide to see the doctor. They are looking for help and relief. However, my impression is that also in many instances, the moment when they make that decision to go to the doctor is the point where they stop thinking about it. I think most patients, who didn’t happen to go to medical school themselves, assume the doctor will tell them what to do.
One teeny detail: With any treatment, the only guarantee is that there is no guarantee.
If you come to see me, you’ll probably hear these points, as I feel like a broken record: *
–I can guarantee I will do the best I can, but I can’t guarantee a result. Some people form more scar than others, some bony fusions (surgery to get bones to grow together) don’t fuse. Sometimes the hardware might get loose before healing occurs, and some cases have problems for unforeseen reasons.
–If I did 100 cases and was super happy with my performance in every case, I know I wouldn’t have 100 happy people. I very rarely will make someone worse, but there are the occasional cases where I think what the patient wants to say is “thanks for trying doc, but it didn’t really help.”
–The word “risk” is describing the possibility that you might have a less than great result, and all cases have risk. No driver can guarantee they won’t get in a car crash.
So, bottom line: though if I were the patient I would be asking the doctor the same question (should I have surgery?), the decision of whether to proceed needs patient input. There is always an option to think about it until you are comfortable with the decision. Unless a patient is facing imminent danger by my not recommending surgery, I will share the options with the patient, try my best to help form a plan, but I don’t push folks into the operating room. The main question, which the patient has to decide is:
“Can you stand it?”
Whatever you decide, we are here to help
__________
*for the young people, sounding like a “broken record” means repeating yourself, as these round things they used to have called records, might have a defect in the groove and might repeat the same part over and over again. That’s your history lesson for the day. 😊
These days, it’s getting harder for doctors (like me, for example) and hospitals to get paid for the work they do caring for patients who…supposedly…have insurance coverage. Call me crazy, but I would think that there is a reasonable expectation that when you have coverage, that you have coverage.
I noted a decline in the willingness of insurers to cover care that really accelerated during the Covid pandemic, and continues now. The attention of the public was on the health crisis, and then as the pandemic issues have wound down, the media has focused on other issues in the news to keep the eyeballs on their screens, but I hear nothing about healthcare or insurance coverage.
While we are all looking away (except for those who need do deal with their healthcare bills), the insurance companies are laughing all the way to the bank.
Look at their business model:
–Take in premiums (revenues),
–Pay for some part of costs of healthcare (expenses),
–Whatever is left over is their profit.
In other words, if they spend a dollar to help you buy your medicine, that is one dollar less that they make. But on a larger scale, if they can find reasons to deny services that cost greater amounts, like elective orthopedic surgery, the insurer will save literally tens and sometimes hundreds of thousands of dollars. And…they have all the control over the medical decisions and no liability!
I can share that as a provider, understanding that while many people are happy with their coverage, I have more frustrations. The denials have become more frequent and ridiculous. Example: I will see a patient with back pain and order physical therapy. For some reason, the insurer denies the therapy. When the patient’s pain gets worse, I order an MRI. Not surprisingly, the MRI is denied. The reason given for the MRI denial? That the patient has not had physical therapy. Pure genius!!
Insurers also deny care by delaying care. Just like the expression that “justice delayed is justice denied,” same goes for medical care. I have many situations where patients are in significant pain, with treatable conditions, and the insurer always wants another form or report or other document, in a process that seems interminable, all while the patient, with a treatable problem, suffers. Worse than that, I have had an insurance company, in the middle of therapy (like wound care, or with antibiotics for an infection) tell the patient that they are not authorizing any additional care. I am quite confident that no insurance executive would stand for any friend or family member of theirs receiving similar treatment.
Though it is patently ridiculous that this type of advice would be needed, and given my impression that many of the denials border on bad faith, here are some tips on filing an appeal:
https://healthyfuturega.org/get-help-with-health-insurance/problems-with-your-health-insurance/
Otherwise, for those occasions where I have written a complaint to the GA Insurance Commissioner about insurance company behavior that I would consider to be bad faith or objectionable, they have sent my complaint to the insurer. It would be like if I were ripped off by a plumber, and I complained to a state agency, and they just sent my complaint to the plumber. 
I would love to be wrong about this issue, but this picture shows my impression of what the Insurance Commissioner does with complaints.
While I grant that there are some docs out there who will run up bills on any patient with an insurance card and a pulse, that percentage of clinical decisions is very small, and the insurance pendulum has swung too far in the direction of obstruction of care options.
Also, given that money is considered speech, and that politicians will need money for their campaigns, and that insurance companies have a lot of money, I don’t see how this situation will change at any point in the near future.
My only suggestion is to keep fighting, keep being a thorn in the side of any regulatory agency, or with the bad press to the insurers on social media, to shine sunlight on this pile of you know what.
Glad I can brighten your day.
😊
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