by Dr. Marc Lavietes, May 20, 2019
Life-enhancing Medical Devices
When my patient, Mr. B.W., told me his breathing-assistance machine had failed, you might (rationally) assume that replacing the life-enhancing medical device he’d been prescribed five years ago would be straightforward: it’s just a replacement machine, after all. You’d be wrong: the process of getting him a working machine has been fraught with multiple, almost insurmountable administrative obstacles. After six months, he still does not have it. This is his story — and the story of so many others.
Mr. B.W’s situation is hardly unique. I find myself spending as much time navigating an unrelenting and confounding insurance-payments maze to get my patients the treatments I prescribe as I spend with patients. Unlike patients with other chronic disorders, the patients I see rely on medical devices—necessary for them to live normal lives. But these devices are often not on the formulary of insurance policies, so I spend hours of every workday explaining medical necessity to insurance employees, most with no medical training, many who have their pay tied to their denying benefits.
For my entire professional career, I have been on the faculty in the pulmonary/critical care division, located in an area similar to the South Bronx, where asthma rates caused by pollution are among the highest in the nation….