An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

The chain of for-profit businesses now involved in precertification magnifies the basic indignity and the errors made. As Dr. Hayes’s office manager tried to get approval for the nuclear medicine stress test, the insurer’s Web site said Dr. Hayes was in the Blue Cross network, but CareCore said he was not. Dr. Hayes himself had to get on the phone to request a peer-to-peer review with a CareCore doctor. After more than a half hour of waiting, and relaying a dozen pieces of information (patient’s name, test code, provider’s code, facility or doctor’s office, diagnosis of chest pain, electrocardiogram finding, lab tests, ICD code, and more), the office manager got approval for an hour-long test, for which Dr. Hayes would be paid anywhere from $600 to $1,200. These wasteful bureaucratic processes have been a lucrative job creator for the business of healthcare. They also siphon hours away from what patients want from their doctor and what good doctors want to provide: human contact.