Is it a moral conflict to work for insurance company?

[Nurse Beth, MSN]

Dear Concerned,

Jobs for nurses in the medical insurance industry have increased, some say tripled, with the shift from traditional fee-for-service payment to value-based care with payment tied to outcomes. Managing patient care takes a lot of coordination and nurses are involved in many aspects, including chronic condition care management.

There are so many different roles nurses can uniquely provide for insurance companies. There's phone triage, utilization review, claims, appeals, case management, and more. Some insurance nurses pre-approve patients for procedures and hospitalizations. All of these jobs include following some type of protocol.

Could that pose a conflict?  I would say yes, in some companies and in some roles, you could possibly be in the uncomfortable situation of being involved in denying care. You could also see it as an opportunity to put your deep experience to work for the good. 

It's not always all about restricting care/payments. Some even companies reward nurses for seeing that patients follow their diets and adhere to their medications to keep them as healthy as possible. 

I think it's absolutely possible to work for an insurance company and help patients.

Perhaps it's similar to the hospital when you spoke up for a patient to spend the night or knew not to discharge a post-op TURP patient with too much bleeding, even though it was scheduled as day surgery.

Best wishes in your decision,

Nurse Beth