Doc describes difficulty of insurance system

Dr. Moshe Lewis currently works at the SOMA Orthopedics Group in San Francisco, where he treats conditions ranging from arthritis to sports injuries and says he spends 50 percent of his time fighting insurance companies for his patients.

How do you navigate the insurance system? I look at each case individually. I don’t make certain choices based on the algorithm or try to memorize insurance — that will get you in trouble. I’m more deliberate. I look at where a patient lives and what they need.

Who’s responsibility is it to “navigate insurance” — doctors or patients? It’s a 50-50 split. The doctor’s role is increasingly becoming that they do research and make choices so there won’t be a delay in treatment, but more knowledge on both ends will help doctors and patients in the long run.

Why is the insurance system so hard to navigate? They are absolutely banking on patients and doctors not knowing the system. They too have a series of algorithms that are so complex even some employees don’t know them. 

akoskey@sfexaminer.com

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