You keep changing your argument from a claim on an insurance policy to a mal-practice claim. It is difficult to follow your arguments because of that.

Here you are claiming that an insurance company has all the necessary paperwork to pay for a claim. That is not true far more times than you would imagine. Often times insurance companies wait for the hospital, doctor and even the patient to send in the necessary paperwork as specified in the insurance policy. Once again, you seem to be taking the approach that any claim that a person files should be paid. If that is the case, please post your address so I can send you bills and demand payment even though I have never performed any work for you.

Insurance companies want to assert all their rights.

So you believe that companies do should not assert their rights? Is that really what you are saying?

So in the instance where a surgeon fails to identify blood type prior to surgery, and during surgery the doctor orders a transfusion but the nurse administers, after the patient dies, the family of the patient should be forced to file a lawsuit to recover, under your logic.

Not only yes, but aitch ee double hockey sticks yes. In your example, what has the surgeon done wrong? He was relying on information that was given to him by someone else. You really don’t think that the doctor does the physical test for blood types, do you? So if a blood type comes back A Pos and the actual blood type is B Neg, what has the surgeon done wrong here?

According to your logic, the insurance company should not be denied the opportunity to accuse others and attack the plaintiff, rather than make a fair offer prior to the statute of limitations.

No, the insurance company should have the right to defend themselves. There have been cases listed on this blog where the patient has not told the doctor or hospital of an allergic reaction to a medicine, and yet the family sues the doctor for the patient failing to disclose vital, pertinent information.

In other words, if you are allergic to penicillin, and when the doctor asks if you are, you reply “no,” how is it the fault of the doctor when you have a reaction to the drug?

Slick, slick, slick insurance company double talk.

You keep repeating this rather than address any of the substantial issues.

I think any reader knows you are more interested in padding insurance profits than a fair resolution to an unfortunate event which caused a catastrophic injury

“Fair” has many definitions to many people. I don’t think anyone is against people, hospitals, insurance companies, etc being held accountable for their errors. However, what is not fair is your belief that any mistake is always that of a doctor. What is not fair is your instance that any claim on a policy or claim of negligence should be paid off without any review.

I would suspect that you don’t handle your affairs that way, so the “fair” thing to do is not demand that others do what you will not.

Wait, an insurance company has access to its insured and once the claimant submits the medical bills, records and statement – what else does an insurance company require to adjust a claim and make a fair offer? Insurance companies possess no difficulty charging high rates and cashing checks, why then does evaluating a claim take so long? Oh wait, are you arguing the statute of limitations should increase from 2 years so that insurance companies have time to make a decision rather than force a plaintiff to file or recover zero?

“In addition, discovery is not limited to the issue of whether the insured breached the standard of care, but also must be done on issues like causation (including medical histories with other providers, the patient’s co-morbidities, etc.), potential allocaton of liability to third parties and/or the plaintiff, and damages, which is usually a contentious and murky subject.”

OH! NOW I SEE!! Insurance companies want to assert all their rights. So in the instance where a surgeon fails to identify blood type prior to surgery, and during surgery the doctor orders a transfusion but the nurse administers, after the patient dies, the family of the patient should be forced to file a lawsuit to recover, under your logic. According to your logic, the insurance company should not be denied the opportunity to accuse others and attack the plaintiff, rather than make a fair offer prior to the statute of limitations. So you argue insurance companies should be able to maximize their rights and force litigation, but if a plaintiff files a lawsuit, then they rely too heavy on litigation and are only after money.

Slick, slick, slick insurance company double talk. I think any reader knows you are more interested in padding insurance profits than a fair resolution to an unfortunate event which caused a catastrophic injury – an injury nobody ‘wanted’ but that fact does not place the injured back into the position they were in without the injury.

Ok sounds great. Only, this applies to both sides, right? If the insurance company – as per their norm – files some bogus defense, then the Court should throw their defense out, right? We all know the cadre of physicians medical malpractice insurance companies keep on retainer – 300k per year to rubberstamp the insurance company “theory” of how the ‘doctor’ never violated the standard of care when removing the wrong leg….

Any expert should have to be court approved prior to litigation so that a Dr. Danial Brown, a hired gun for repressed memories, is never allowed to vouce for a thoroughly discredited theory.

It also allows the parties involved to assess the complaint to see if there is merit to the complaint. Once again, you seem to think that just because someone claims malpractice that the insurance company and the doctor are negligent.

Complete myth.

Obviously the conclusions of this study and others have escaped you.

Doctors order more tests for two reasons: 1. more information and 2. more money.

We’ve been down this path before. Your repeated assertion that is against this and other surveys doesn’t sway me.

As far as the point regarding a “non-research study test”, a study often pays for tests and does not bill the particular patient.

Ah. I see what you are saying. So you believe that a doctor in private practice orders a test and makes money from it? Once again, your assertion is contrary to real world experience.

Yet, each and every medical malpractice insurance company that is forced to present their financial records to the public shows two items: 1. huge profits and 2. dividends to their physicians.

I am not sure of your point here. Yes, med mal insurance companies make a profit. That is what companies are in business for. The next time you go to work and don’t want a paycheck, you can criticize others who want to get paid. Secondly, if a doctor or anyone wants to own stock in a company, that is their choice. Your premise is that an insurance company makes money by promoting increased costs. Good luck selling that to any economist.

Yet, all this talk of money and tort reform has no effect on the rate of medical error in this country.

This is an interesting conclusion as you seem to admit the defensive medicine as practiced by many doctors has no effect on health care. Therefore, the only reason for the defensive medicine and associated costs are to protect the doctor. It has nothing to do with clinical care.

Which is, of course, the conclusion of the aforementioned surveys and others before it.

Agreed. However, again you fail to distinguish between “trial” and “filing a lawsuit”. When you file a lawsuit, you do not automatically have a trial; instead, the procedure allows for a lengthy process of discovery. This lengthy process allows insurance companies to delay payment or settlement until the day of trial nears or on the day of trial.

Or the doctor is practicing defensive medicine, which is the subject of this post

Complete myth. Medical schools offer no courses on “defensive medicine.” Hospitals offer no training programs on “defensive medicine.” Insurance companies offer no lower premiums for medical malpractice for those doctors practicing “defensive medicine” versus those doctors not practicing “defensive medicine.” “Defensive medicine” is an insurance term used to defend failure to diagnose cases.

Doctors order more tests for two reasons: 1. more information and 2. more money. A very logical relationship exists with doctors ordering tests and increased pay. If a doctor works for a hospital and wants a raise, then the hospital must spend more and in turn charge more. Those doctors possess a perverse incentive: want a greater salary, then obtain more revenue. While I agree that some other entities bill patients for the services, many doctors OWN those other entities. See Texas:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

As far as the point regarding a “non-research study test”, a study often pays for tests and does not bill the particular patient. Thus, a study may often pay for tests to learn information for non-clinical reasons.

I believe that the casual reader will disagree with your assessment of this discussion.

I challenge you to evaulate a different statistic: medical malpractice company profits. Since you argue that insurance companies pay $150 for every $100 they take in premiums, logic dictates they would lose money. Yet, each and every medical malpractice insurance company that is forced to present their financial records to the public shows two items: 1. huge profits and 2. dividends to their physicians.

Yet, all this talk of money and tort reform has no effect on the rate of medical error in this country. Since the rate of error remains the same and 70 million baby boomers are poised to enter the stage of their lives requiring the most medical care, the baby boomers will experience a very bloody experience. Insurance companies have taken great strides – like the writer above – to paint this rosey image, but the boomers love to asset their rights ( ironically, they spent the majority of their professional lives eroding individual rights).

Clearly this is contradicted by real world experience.

In fact, over 70% of all med-mal claims are settled before a trial. Of the remainder that go to trial, the physician is found not negligent 90% of the time.

It seems that you believe that a mere claim that a doctor was negligent should result in an award. Heaven forbid that we actually allow people to defend their actions and reputations.

If the test adds something ‘other than for a clinical reason’, you can bet the doctor is gaming the system – greedily grabbing cash, just like their insurance companies.

Or the doctor is practicing defensive medicine, which is the subject of this post.

Texas – home of the most strict tort reform measures – possesses the HIGHEST cost of medicine in the country. IN THE COUNTRY!!!

Factually false: http://www.peerpapers.com/uncommon-sense/wp-content/uploads/2009/07/HealthcareMap_Final5.png

Of course, where you might find that the state with the second highest population in the country spends the second highest amount for health care to be shocking, most people would believe that would be right in line.

Neither resopnse above addressed my question, name one non-research study funded test that a medical provider does NOT bill the client for?

Frankly, I am not sure that a “non-research study” exists. How can you have a “study” without “research?” That alone would make your question impossible to answer.

However, you have retreated from your original point which was that doctors make money off of tests. They do not. Secondly, if you think that more tests mean more money for the insurance companies, that would be false as well. Assume for a moment that a person pays $100 a month for health insurance. (The figure is just for illustration purposes and is not real.) Also assume that each test costs $25. (Once again, just for illustration.)

You are trying to get us to believe that the insurance companies make more money by having doctors order 6 tests for a total of $150 than 1 test at $25. I fail to see how a company losing $50 is a benefit to that company or its shareholders.

Neither answers, but both provided slick insurance company doubletalk.

I believe that the casual reader will disagree with your assessment of this discussion.

Insurance companies hire individuals called “adjusters.” An “adjuster” evaluates a claim and makes a decision on the claim. Medical Malpractice Insurance adjusters evaluate the medical records of the claimant, the statement from their insured (the doctor), the statement of the claimant and consult a ‘hired gun’ doctor who evaluates whether insured violated the standard of care. Adjusters also discuss claims with “in house” counsel, ie defense attorneys, as to the liklihood of success at trial. After evaluating a claim, the adjuster can take three actions 1. make an offer to settle – which they never do, 2. deny the claim or 3. neither make an offer or deny the claim. Most medical malpractice insurance companies select #3 in order to force a lawsuit.

Interestingly, ARD, above, wants the insurance company to “proceed through discovery and attend an arbitration or mediation.” Why? The insurance company possesses all the material, possesses all the expertise to determine whether a violation occurred! Why then does the insurance company force an arbitration or mediation – after forcing the plaintiff to file a lawsuit? Because medical malpractice insurance companies make their living attacking claimants in order to make more money.

Insurance companies employ slick logical slogans – like “when other doctors would order a test, that becomes the standard of care”. Come again? The survey asks “other than purely clinical reasons”. If other doctors are ordering the test for ‘clinical reasons’, then that becomes the standard of care. If the test adds something ‘other than for a clinical reason’, you can bet the doctor is gaming the system – greedily grabbing cash, just like their insurance companies.

Interestingly, Texas, Indiana and California provide a great deal of evidence that doctors and insurance companies act primarily for money. Texas – home of the most strict tort reform measures – possesses the HIGHEST cost of medicine in the country. IN THE COUNTRY!!! Neither resopnse above addressed my question, name one non-research study funded test that a medical provider does NOT bill the client for? Neither answers, but both provided slick insurance company doubletalk.