Harnessing patient power: Another approach in handling insurance disputes

Patients who deal directly with insurers are often more successful at resolving problems. But asking a patient to intervene should be a carefully considered decision.

By Pamela Lewis Dolan, AMNews staff. Feb. 5, 2007.

Mark Granoff, MD, spent more than an hour on the phone with an insurer trying to get approval for a non-formulary medication. Three separate phone calls and no headway later, he handed the proverbial baton to his patient.

Dr. Granoff, an internist and geriatrician from Los Angeles, said he generally likes to handle disputes himself. But in cases where he clearly is getting nowhere, the former medical director for Blue Cross of California knows from experience that it's the patient who holds the power to get things done. Sometimes getting the patient involved is key to getting a dispute resolved.

Insurers "are not anxious to make the patient unhappy," Dr. Granoff said. "They are the ones paying."

Getting a patient directly involved with insurance disputes can be tricky and can require some coaching from the physician. But if done at the right time and in an appropriate manner, it can pay off.

Because patients have been paying more out of pocket for their health care in recent years, some doctors feel patients are more willing to fight for benefits. And the time patients spend advocating on their own behalf is time physicians can devote back to patient care.

Kathryn Stewart, MD, MPH, a family physician and director of care management at Mt. Sinai Medical Center in Chicago, said she used to spend a lot of time on the phone advocating for patients.

"But in this day and age, it's just not practical for primary care physicians to do that anymore," Dr. Stewart said. "Doctors are increasingly pressed to see more patients, and many are having a difficult time staying out of the red."