“Over the past few years insurers have heightened pressure on physicians to do what is in their best interest, as opposed to the patient’s. They dock our pay for ordering more tests or using more expensive medications than they deem desirable. They throw obstacles in our paths — really in the way of our patients — banking that we won’t go forward, because surmounting them takes so much of our already limited time. Roadblocks placed in the way of certain medications are ‘prior authorizations.’ … Equally, if not more burdensome, is ‘pre-certification,’ the process required to gain approval for anything other than a simple X-ray for many patients. All of this raises two questions: How can physicians meet patients’ unique needs given the increasing restrictions imposed by health insurance companies? How can we exercise the medical judgment we spend years cultivating when we’re routinely put on the defensive by having to ‘make the case’ for any exceptions to the default course of doctoring insurers prescribe?” [editor’s note: It’s a lot more complex, but this is part of the problem. - SAT] (06/29/06)