A little anecdote that may help explain some of the escalation in insurance premiums that people are about to find as year end approaches - for reasons other than the colossally intrusive and costly ObamaCare.
I saw a patient in the office a couple of weeks ago. A gentleman in his 40's, he had twisted his knee two months earlier and since had been bothered by knee swelling, pain along the joint line medially (the inside part of the knee), and a catching sensation which cause his knee to buckle when it occurred. He was unable to squat or kneel. I examined him after taking the history, finding an effusion in the knee (the swelling), sharply positive provocative testing for a meniscus tear (the McMurray and snap tests), and prominent joint line tenderness directly over the meniscus. Plain x-rays showed no degenerative changes. And there's one other thing. This patient had a very similar problem with the other knee four years ago, and I had arthroscoped that knee removing a torn medial meniscus with an excellent outcome.
So, clearly, this man had a symptomatic torn meniscus, with most probably an unstable flap tear (producing that catching/buckling sensation). This is about the most clearcut, obvious presentation you could have. He had had symptoms for two months, and anti-inflammatories had not helped. I, quite appropriately, suggested arthroscopic surgery to resect the torn meniscus. I've examined thousands of knees, and I had seen this many times before. Based on the plethora of findings given above I didn't need an MRI of this knee to confirm the diagnosis. I thought that was what the insurance company wanted, to save money by eliminating unnecessary testing. I was wrong.
The insurance company, a large HMO, refused to approve the surgery until the patient had an MRI to verify what I knew to be true. I didn't need one, I told them, but they insisted. The patient had the MRI, and of course it demonstrated the torn meniscus. We'll be going ahead with the surgery soon.
Trust the doctor? Not on your life. No, instead we need an expensive diagnostic study read by a radiologist who hasn't examined the patient, increasing the cost of care on this one patient. Now picture thousands of orthopaedic surgeons and hundreds of thousands of patients annually having the insurance company second-guessing the experienced surgeon. By the way, my practice has our own MRI, and I still tried not to use it.
I tried to save some health care dollars. I really tried. But the insurance company wouldn't let me.
You think this is bad? Wait until I tell you about PT for rotator cuff tears.