To the Editor:

I received a letter the other day from an insurance company informing me it would not pay for office urinalysis because its “medical staff” decided that under the company’s reimbursement policy, the reagents, specimen cup, reporting form, gloves, hazardous-waste disposal and office personnel involved in this test were “incidental” and therefore worth nothing. If a dipstick urinalysis is incidental to an office visit, how about a hemoglobin, hematocrit – or even a CBC? There is no end to this slippery slope.

More and more, we’re seeing insurance companies and Medicare climbing into the driver’s seat. For years they’ve felt they have the right to call the tune because they pay the piper. But, like the ill-fated council members of Hamelin, they now want to call the tune and not pay the piper. Allowing insurance companies or Medicare to decide what they’ll pay and when they’ll pay it is like asking someone who owes you money how much he or she feels like paying. Try getting insurance coverage without paying exactly what they charge.

Several years ago the major HMOs garnered enormous profits by drastically cutting back payments to physicians and hospitals for medical care. Then they invested large amounts in buying medical practices. Now they’ve been quietly backing out of those investments since they’ve discovered that dismal payments from medical insurers like themselves have made it nearly impossible to run profitable group medical practices. They’ve discovered that insurance companies and Medicare have all but ruined the practice of medicine.

The revolt is long overdue. It’s time for us to take back our health care system.