Even doctors have trouble getting necessary procedures approved by insurance

It’s not just ordinary people who sometimes have to fight with their insurance company over necessary procedures. This occurred with Mercer Island MD and regular guest of Seattle’s Morning News Dr. Gordon Cohen, who joined the show to discuss his own experience.

“I had a condition called cervical stenosis. It’s actually the second time I’ve had it. It actually happens quite frequently in surgeons — in fact, some people call it surgeons’ neck — I had a narrowing of the space where the sixth cervical nerve root comes out between two bones,” he said.

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“And so three years ago, when I had a problem, my surgeon Dr. Addison Stone — who I think is one of the best surgeons in the country — enlarged the area around the nerve by cutting away bone,” he explained. “And so that was a minimally invasive procedure.”

While he has some relief for years, the problem came back, and he had trouble getting a second procedure approved by insurance.

“So once I got the MRI and the MRI showed that there was this problem, you would have thought that it would have been a no-brainer to just go ahead and approve it. But in fact, no, they want other things done first before they’re going to approve an operation,” he said. “I ended up going through physical therapy, I ended up having multiple injections of steroids into my neck.”

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“It’s not ideal that we’re in this position where, you know, both patients and physicians are fighting with insurance companies in order to get them to authorize care,” he added.

While Dr. Cohen was able to eventually get the surgery after three months, the experience highlights issues that many people have, as Dave suggested. Because if it took a doctor that long to get a necessary procedure, what hope does someone who’s not a doctor have?

“In the midst of my frustration, I was actually saying the same thing all the time,” Dr. Cohen said. “I mean, here I am a physician and I at least know what’s going on and could explain it and have, you know, pretty direct access to my surgeon. … The average person really is at a loss for being able to get things done in a timely matter. And the problem is that you’re then forced to live with discomfort, or you’re forced to live with something that’s progressively getting worse.”

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