“Will my insurance cover my stay?”

This is a question I can’t answer with certainty. Patients often believe that since I’m part of the health-care system, I would know. But I don’t, not as a doctor — and not even when I’m a patient myself. In the United States, health insurance is so extraordinarily complicated, with different insurers offering different plans, covering certain things and denying others (sometimes in spite of what they say initially they cover). I could never guarantee anything.

That is the response form Dr. Helen Ouyang, a physician and associate professor at Columbia University in a recent N.Y. Times Guest Essay. Dr. Ouyang continues on to say that insurance coverage–rather than evidence based medicine–often guides prescribing decisions.

One of my first lessons as a new attending physician in a hospital serving a working-class community was in insurance. I saw my colleagues prescribing suboptimal drugs and thought they weren’t practicing evidence-based medicine. In reality, they were doing something better: practicing patient-based medicine. When people said they couldn’t afford a medication that their insurance didn’t cover, they would prescribe an alternative, even if it wasn’t the best available option.

Another problem is that the complexity of the US health care system erodes patient trust in physicians.

When doctors can’t give a straight or accurate answer, patients may lose faith in them. What’s more, when insurers reject claims, they usually blame the provider — the medical code used was wrong, the diagnosis wasn’t specific enough — which can further erode the relationship between patients and their doctors.

We need health insurance. It covers the care we need when we are sick. Not only that, but health insurance plays a vital role to insure that patients are getting good value for the care they are getting. However, as the bureaucracy has grown as well as the cost of health care, physicians, patients and the physician-patient relationship has suffered. There are no easy solutions but we must all work together to make the US health care system better.