It is apparent that patients on Medicaid receive a different level of care than those who can afford to purchase their medical insurance, which is unfortunate. The standard of care should be equal to all patients regardless of who the insurance provider is.
One of the main differences is the withholding of certain procedures (such as MRIs and CAT scans) and is due to the rigid process of pre-procedures – such as steroid injections, physical therapy, pharmacotherapy and X-rays which, collectively, add up to a considerable cost.
The conservative therapies must be exhausted prior to authorization for an MRI but they are not always necessary nor are they cost-effective. While I understand the need for some form of protocol prior to authorizing an expensive procedure such as an MRI, it is unfortunate that the patient’s individual needs and medical history are often overlooked in the process.
The medical directors within the Medicaid system need to work collaboratively with the physicians who are the “eyes and ears” of the government-subsidized program. The opinion of the medical professional who is caring for the patient should not be underestimated.
Perhaps the pre-procedure requirement for MRIs should be used as an outline with patient differences and prior health issues taken into consideration to provide the best patient-centered care while still minimizing cost.
(Phillips is a registered nurse.)