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How insurers ‘set up patients to fail’

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David Russo, M.D., an Oregon psychiatrist, writes about how insurers set up patients to fail.

He writes in the (Portland Oregonian):

“Here’s how it works: First, a doctor comprehensively evaluates and diagnoses a patient’s health condition and counsels them about the benefits and trade-offs of various treatments. Then, the doctor prescribes a therapy best suited to the patient’s condition. But, more often these days, patients are stymied by the insurance company’s denial of the physician’s plan. Making matters worse, insurers will only approve the physician’s plan after the patient proves that they ‘failed first’ on the insurance company’s preferred alternative.”

“Patients shouldn’t suffer at the hands of insurance providers’ cost-cutting measures. It wasn’t Edison’s failure to first improve the candle that led to his breakthrough invention of the light bulb. When my patients fall victim to the arduous step therapy system, I join forces with them to battle the approval processes until they receive coverage for the right treatment plan — without substitutions.”

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