Do insurance companies pressure docs?

My endo won't keep me as a patient unless I see him at least 2x a year. He says insurance companies complain and have even reported him for not taking care of his patients if they don't see him 2-4x a year. Anybody heard of this?

Yes, it’s called standards of care which includes 2 to 4 visits a year for those with diabetes. Physicians are monitored on patient outcomes and may eventually be reimbursed this way vs fee for service. Which really isn’t fair because how do you determine or evaluate outcome based çare for a family practice Dr vs an oncologist or cardiologist or endocrinologist or other specialists who are ultimately referred the sickest patients? Also patients have the right to refuse treatment. Just because something is recommended doesn’t mean you have to do it or that it’s the best treatment for you.

On the other hand I don’t think regular appointments with the endo are unreasonable given that I need current prescriptions for insulin, pump and pump supplies, sensor, and thyroid medication. Not to mention all the hoops my insurance requires in terms of preauthorization sometimes.

Good to know my doc is on the level. From my perspective, I truly don't need to see a doc more than 1x a year for my T1 and actually I think of the appointment as my way of paying him to keep writing my scrips. As to why I need continual re-authorization of scrips for a condition that will never go away is a whole other topic.

It is not just diabetes or insurance companies. When I saw my cardiologist, He checked my lab work from my endo and noted that there were no LDL/HDL results. I pulled out the lab results from my GP and asked if they would do. Upon checking them, he stated that it contained everything he needed. Then he said that there is a review board that checks the doctors and if they do not check certain things, they are deemed not doing there job. So the insurance companies and large medical practices/hospitals are reviewing the care the doctors are giving the patients. Sometimes this is to our best interest, sometimes not.


If you only see the doc once per year, how do you get a1cs done regularly? Or do you? Yes, I did a lot of individual testing, but regular a1cs are also a good tool to see how you are doing.

Me too, Don. I do the once a year check up for all of my health needs and get all the labs and then all the scrips (my main reason for the visit). And the A1c is just an added expense that means little to me, and over much to everyone else. I need to know what my bg is now. My insurance does not dictate my standard of care to me or my doc(s). If I call my doc, I get an appointment pdq...because when I do call I have something wrong. For check ups and labs, she calls me to remind me it's time.

You have a good regimen, Karen. After 9 years, my learning curve and diabetes management is maximized and going 2x a year vs once will make no difference to my health. My endo agreed with me that the A1C is less relevant than fingersticks. He said the A1c is a nice data point for medical studies but for the PWD fighting the good fight on the ground, fingersticking is the key. But hey we don't make the rules.

Thanks, Don. I found a really good doc who trusts me to manage my condition(s). I like your endo and agree wholeheartedly. The one thing that I can't figure is why folks need to see the endo every three months...when I need labs or follow ups my doc just sends an order to the lab, I pop in to the vampire center, give some tubes of blood and leave. She calls with the results, and asks me to come in if something is amiss, or it's my yearly. Seems like an unnecessary expense to me to have to pay for an appointment to look at some numbers. If my insurance required this I would insist it is on their dime! Endo docs charge a lot for a short visit!! Hopefully yours are covered or there is only a small copay :)

I like getting regular A1Cs. My old doc was twice/ year, then I had a hypo and then another one that were exciting, one of which featured an added cardio element (EMT "Woah, look at that, you need to go see your doctor *immediately*!") but it all went away so then she wanted to see me every three months, which was ok, as I then had total A1C coverage, which was sort of handy. I understand the criticism of the test and the criticality of "what's my bg now?" as karen put it but I also like having the double check or benchmark of how the strategy is turning out based on whatever my 800 tactical plans since last time are. I think that 2x/ day is reasonable although really, it's sort of a waste of time, since I mostly get patted on the head. Both my PCP and endo are into working out and I've had some good conversations with them about stuff so I will keep seeing them regularly.

I am resigned to being "patted on the head" twice a year, lol. On the plus side, my endo thinks for himself and isn't an inflexible med-bot.