Defensive Medicine, Trial Lawyers, And Insurance Company Crisis
Much is made of so-called “defensive medicine” by the politicians and organizations who advocate for tort reform. If you are unfamiliar with the concept, “defensive medicine” is what happens when medical professionals operate more out of a fear of being sued rather than simply doing what is necessary for the patient. In other words, if you come in with a sore ankle, rather than simply asking questions, maybe ordering an x-ray and then diagnosing you with a sprained ankle, the doctor will put you up in a room for the night, order a full MRI of your ankle and call in a specialist in order to give your ankle a thorough examination. They don’t want to take the chance of missing anything so they won’t get sued later.
This would all be fine and dandy except for the fact that health care is incredibly expensive. And since somebody has to pay for all of these extra tests, that burden will fall on the insurance company. So, as the premise goes, health insurance companies end up getting billed for wildly expensive procedures, which forces them to drive up the costs for everybody, which then makes the insurance companies raise their rates, and all of this is based on trial lawyers waiting to sue at the drop of a hat.
There are many things that don’t make any sense at all about this argument. In the first place, it completely misrepresents the relationship between hospitals and insurance companies. If it were true that insurance companies were contractually and legally bound to pay for every single healthcare expenditure made on a patient’s behalf, then perhaps the tort reformers would have a point. But insurance companies most certainly are not contractually and legally bound to pay for everything. They have agreed to pay for what they deem to be “medically necessary”, and not that which they deem to be “medically unnecessary.” And “medically unnecessary” can mean quite a few things. In fact, “medically unnecessary” can be and has been applied to almost every single pill, bandage, test and procedure that exists underneath the roof of any hospital in America.
Insurers have refused to pay for aspirin, bandages, calcium pills, ambulance rides, helicopter trips to the emergency room for patients at deaths door, broken limbs, lab tests, surgeries both major and minor, limb or finger reattachments, meals, or quite literally anything medical that you can imagine. And these decisions are almost never made by the reasoned decisions of uninterested and unbiased medical professionals. They are made by insurance claims adjusters using insurance company software to guide their decisions of what is and what is not medically necessary.
In short, insurance companies do not simply receive an invoice and then meekly write out a check. They say “no,” and leave it to either the hospital or the patient to convince them to say otherwise. If the patient or the hospital fails to do so, the hospital simply bills the patient. So the idea of hospitals overloading patients with unnecessary tests to either avoid the lawyers or just to get rich is not an accurate one. No insurance company that we have ever faced in court simply acquiesced to anything. So it is very doubtful that they would simply fork over money for an MRI given to a patient with a headache.
This is another example of insurance companies inventing a “crisis” in order to create new laws that will only benefit them, even as they claim that these new laws will benefit everyone else. The “crisis” of “preventive medicine” putting an undue burden on insurance companies does not exist. Nor did the “crisis” involving medical malpractice, in which doctors were supposedly being run out of business due to a sudden increase in lawsuits.
The invariable solution to all of these invented panics is always “caps,” or arbitrary, unfair and unrealistic limits on the amount of money that victims of injuries or medical malpractice can receive. These caps will not prevent doctors from running unnecessary tests and they won’t cause medical malpractice rates to drop or raise or lower the amount of malpractice cases that are filed, settled, won or lost every year, and they will ultimately do nothing except benefit medical malpractice insurance companies, which are the one part of this equation that doesn’t need the help.
Greenberg and Bederman is amedical malpractice injury law firm located in Silver Spring, Maryland. We have helped malpractice victims in Virginia, Maryland and Washington, D.C. for 25 years. Our practice areas include surgical errors, missed or late diagnosis cases, prescription errors, birth injuries, and many other forms of medical malpractice. If you or a loved one has been injured due to what you believe to be medical malpractice, contact Greenberg & Bederman for a free legal consultation.
![BlogSearch.com](<A HREF="http://www.blog-search.com"> <IMG SRC="http://www.blog-search.com/images/smallbutton.gif" WIDTH=80 HEIGHT=15 BORDER=0 ALT="Blog Search: The Source for Blogs"></A>...){kind=link}