Can you believe it?
The CEO of most medical insurance companies rake in huge salaries, so nothing infuriates me more than a patient of mine being denied a medically necessary procedure because "Big Brother" deemed it unnecessary. "Big brother" I might add, is usually some twerp in Bangalor, India, who knows as much about the medical field as I do about aerospace engineering. Sometimes their responses are so absurd I have to threaten a law suit, a complaint to the Department of Insurance, and a request for the exact spelling of their name before I can "persuade" them to see things my way.
Case in point: A patient of mine had such baggy upper eye lids that the droopy skin fell over her eyes and interfered with her vision. She also complained her eyes felt tired and heavy. After consulting with a plastic surgeon, we called to obtain an insurance authorization for the blepharoplasty needed to remove the sagging upper eye lid skin. Imagine our disgust when her insurance company responded they would only pay for one eye to be done. Thus, one eye would look perky, young, and wrinkle-free, while the other would look even more droopy and saggy in comparison. The end result? She'd look like a freak. A cyclops.
Then I had a patient who developed an aggressive form of breast cancer necessitating a bilateral mastectomy. Just thirty-four years of age and single, she obtained breast implants. Unfortunately, after several years, one of the implants ruptured and she was left with a huge blob of the plastic implant capsule lumped unnaturally on the side of her chest. She could not wear any snug-fitting tops or swim suits without feeling self-conscious.
I applied to get the popped implant removed and a new saline implant inserted to match the size of her other implant. Her insurance company, however, refused to remove the blob of capsule "unless the pain is so unbearable she requires narcotic pain medications."
Disgusted, I called the medical director to appeal the decision. She shouldn't have to take Ibuprofen for the rest of her life, risking a stomach ulcer, when the ruptured implant could easily be removed. He responded, "Fine, we'll pay to remove the popped implant but not to put another one in."
I argued with him: "She's single and only thirty-four years old. She can't walk around the beach with one breast implant a size 38C and the other side as flat as Kansas prairie. It's bad enough she's had to face breast cancer, chemotherapy, and bilateral mastectomies. How can you leave her emotionally traumatized and feeling like a freak?"
The jerk medical director blew me off. "Bust size" is not my concern. Replacing that implant would be purely cosmetic; I won't approve it."
Unfortunately, my poor patient couldn't afford to replace the implant herself. What really galled me was this same medical director approved another patient's Viagra prescription with no hassle whatsoever!