The point of insurance is that it should not matter. Some providers may charge more, some less, insurance should care about the average. In other countries you may be treated by great doctors and still be covered by statutory insurance.
Patient primary expectation is always to have a doctor they can trust. That can be fixed only when all doctors get the decent money and comfortable work environment and that means several things: the less middlemen the better, the cost of living including housing should be affordable and put them in middle class, the treatment standards should give them enough time and flexibility, etc.
Didn’t, in this case, the insurer care precisely about the average—setting reimbursement at the average rate for people receiving masectomy care in the state?
Doesn’t it say that most people post-masectomy get “a relatively straightforward surgical procedure using implants filled with silicon or another gel,” which, judging by how unusual the article makes out this surgical center to be, seems to have medically reasonable outcomes?
One big argument missing here is why the “natural reconstruction” option is different from the normal option, aside from the patient who explained that “the idea appealed” because she “felt like [she] was taking something foreign out of my body, cancer, and [she] did not want to put something foreign back in.”
So it seems like, faced with this medical need, some people want a procedure that involves “five operations” in a setting “combining the luxury feel of an upscale plastic surgery practice with the mission-driven zeal of a medical clinic,” where instead of the implants the proprietors do “lengthy and complex operations [that] can last up to 12 hours with big medical teams involved.”
It’s true that the latter probably costs more than the average—and it’s more than reasonable that, when it comes to their own care, anybody might prefer the luxury (or just humane) setting and the dozens of hours of painstaking hand-reconstruction.
It’s also obvious (and settled in court) that the insurer got up to some shady business in this particular case (not least the “for me but not for thee” stuff).
In the general case, though, I have a hard time making the case that it’s fair for a patient’s preference alone to be enough to justify bumping the cost by an order of magnitude or two—especially since insurance spreads those costs out among all the other people paying for insurance, not the dastardly execs directly.
If you can afford luxury then pay extra for luxury, fine. But the insurance feels to me like it’s there to meet the basic medical part of the requirements.
Oh agreed—that seems reprehensible on its surface—not that I imagine it was anything the people involved took lightly.
But in the spirit of, in your professional capacity, taking care of the people you owe a professional duty to before you take care of yourself (in the material sense, at least)…
One imagines these families in particular could afford the difference for the premium care, on their insurance-company-executive salaries.
"Patient primary expectation is always to have a doctor they can trust. "
I don't believe this was the expectation here - trust was not even mentioned. Only credentials were.
I don't disagree it should be the expectation, but it's definitely not in the US and i don't think you'll get there without changing how people think.
Even when it is, trust here seems to be often equated to "how impressive/popular a doctor they are", rather than "how effective a doctor they are" or something sane. At least in the US, the doctors patients trust the most are the ones with the most credentials, awards, etc. It's a popularity contest instead of a baseline competency contest.
If you listen to lots of people in the US talk about choosing and trusting doctors, it's about what school they went to, or what awards they've won, or who else they've treated. Not always, but lots of times. This is not a new thing.
For example - my parents (in their 80's), all of their friends, and heck everyone i've ever met in their community is the same way, and have been for at least 50 years. They don't actually trust doctors who didn't go to harvard, etc.
Patient primary expectation is always to have a doctor they can trust. That can be fixed only when all doctors get the decent money and comfortable work environment and that means several things: the less middlemen the better, the cost of living including housing should be affordable and put them in middle class, the treatment standards should give them enough time and flexibility, etc.