Doctors vs. Medicaid: Who decides treatment?

MIAMI (AP) - Who should ultimately decide what treatment is medically necessary - a doctor or a state health agency?

Florida, Georgia and Alabama are arguing before a federal appeals court in Atlanta that Medicaid officials should have the final say in how to treat Anna Moore, a 14-year-old Georgia girl who suffers from near daily seizures.

The state is trying to reduce the number of hours she can be treated by a home nurse, despite her doctor's recommendations.

Health advocates say the case could set a dangerous precedent if
state health agencies and their for-profit contractors are allowed to decide which treatments should be administered, since they will consider cost before health needs.

But the states say doctors often prescribe experimental and unproven treatments that they shouldn't have to pay for.

(Copyright 2009 by The Associated Press. All Rights Reserved.)


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  • by John Location: Dothan on Mar 31, 2009 at 08:33 PM
    What an absolutely stupid question! Why settle this in the courts? Do what the HMOs do, let the decision be made by a highly qualified customer service desk associate living in Pakistan and who always seems to know more about your medical condition and associated treatments, and prescribed drug therapies than someone who has gone through years of schooling, professional in-resident training, continuing education and self-study to meet (and often times exceed) local, state and federal medical credentialing requirements; not to mention being a daily practitioner of the science and art of healing: your doctor. Unless I'm mistaken, almost all medical courses of treatment began as experimental therapies. That said, I trust my doctor and not some politician or bureaucrat. If left up to them, the only treatment option available at government expense would be the Dr. Jack Kevorkian euthanasia out-patient treatment method and they'd still demand their payment in advance.
  • by Krissy Location: Geneva on Mar 31, 2009 at 02:37 PM
    That is an interesting political answer to deflect responsibility for the original question. Question was about a needed treatment. But answer was talking about an experimental treatment. Medicaid and other insurances often overstep boundaries and oppose good responsible prescribed treatments from reputable doctors basing decisions on cost rather than need. They limit the number of visits, they say a certain medicine is not covered etc. Very frustrating.
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