One of the things I find most offensive about the managed care companies here in California, people don’t realize how many people are affected by this, the market penetration. The three largest HMOs in California – just three companies – ensure 20 million Californians. Between Kaiser, 8.5 million; Anthem Blue Cross, another 8.5 million – that’s 17 million right there – and then Blue Shield, just under 3 million. That’s almost 20 million people that are ensured by only 3 companies.

All of these companies have a system set up to where they have these people they call medical directors that work for them. These are licensed medical professionals who don’t practice medicine. They’re not treating patients. These are people whose job it is is to sit behind a computer terminal and then receive requests for care from actual treating physicians and now are looking at a computer screen at the particular treatment that’s being recommended for a particular disease and making decisions on whether or not people are going to get treated by their own doctor.

These decisions are made without ever talking to or seeing the patient. Oftentimes without not talking to the treating doctor to find out why it is they’re recommending it. Instead, they just deny it and they shift the burden to the doctor, now, for the patient to try to be an advocate to fight them to get the care.

Good treating physicians all over the country and here as worse than ever, and anywhere in California, spend a good part of their day fighting with insurance companies trying to get insurance companies to agree to let them treat their patient. That’s what’s going on factually.

Legally, for over 30 years, the California Supreme Court has already spoken and says and has held that if a treating physician recommends treatment for their own patient, then unless their recommended care falls below the standard of care, that it should be given. But it’s widely ignored. And so a big part of our practice is every day dealing with people who are being denied care as not being medically necessary.

Think about that for a second. You’re a treating physician. You’ve been trained in your area of expertise and you’re telling your patient, and now your patient gets a letter from an insurance company saying that what your doctor is telling you is not medically necessary. It’s really frustrating. But that, because that’s the way it is, it’s a big part of our practice.