Paperwork
Filed under: Medicine
There are days when the bane of my existence is insurance companies. Today was one of those days.
Six requests demands for prior authorization for medication today. This means that the insurance companies have decided with their infinite wisdom that the medications which I carefully chose, given the whole of my patients’ situations, were not the proper choices, and that they, the insurance companies, who have never actually seen the patients let alone examined them, know better. I understand that the goal of the insurance companies is to make money. I also understand there are doctors who prescribe only the latest most expensive drugs all the time. I am not one of those doctors. The drugs I select are chosen for a reason — they’re the best option for my patient. The overwhelming majority of the time they are generic drugs, but occasionally, that-s not an option. My prescription costs are among the lowest in the state. I frankly do not appreciate some corporate flack denying my patient the best therapy without even taking the time to review the patient’s chart (let alone, you know, gaining some actual medical education). Thanks to hard work by my nurse, all six authorizations were obtained and the patients received the medications I requested, but at a cost of over four hours of repeated phone calls and faxes. What makes it even more frustrating is that three of the authorizations were for drugs the insurance companies did not realize had been generic for the better part of a year and met their published guidelines; they were being refused based on old information.
Meanwhile, a “helpful” letter from an insurance agency arrived telling me that my patient was on two drugs of the same class. A quick look at the information let me know that Drug A ran out at the end of April and Drug B was started at the beginning of May. Therefore, the patient was never on the drugs at the same time and it is clear they were switched from Drug A to B. Furthermore, the records provided by the insurance company clearly show that I did not prescribe these medications. The drugs in question were in fact prescribed by the patient’s cardiologist. After perusing the letter, the insurance company now wants me to fill out a form and mail it back to them stating how I used the information in the letter. There are a series of questions with multiple-choice answers. None are realistic. For example, when asked how I will address the “overlapping” medications, they provide only two choices: 1) I have already stopped the medications, or 2) I will call the patient or see them in my office and then stop the medications. Nowhere is there any option for me to inform the insurance company that A) there is no overlap, B) I did not prescribe these medications — a specialist did, and C) even if there were an overlap, I trust the cardiologist’s decisions because she’s the best in the town. At then end of the form is a question inquiring whether I find this information helpful. I always check the “No” box (really, really heavily). Repeat this most days of the week, sometimes two or three letters a day. One of these mornings, I may lose my polite veneer and scribble my real thoughts on the page before I send it back.
And politicians wonder why are fewer and fewer physicians going into primary care.
September 15th, 2006 at 8:51 am
Ouch. Stupid insurance bureacracies.
I’m sorry you have to put up with such crap in a job you love so much.
September 15th, 2006 at 10:05 am
You know, I never thought about this from the doc’s pov. My wife has had some stomach problems, and her gastrointerologist has been trying a few different things for her. After about the second different perscription, we had to get everything rpa’ed. It was a real pain in the rear.
I understand that it’s the insurance companies job to make money, and you’ll never find me arguing against that, but a lot of this stuff is just ridiculous.
September 15th, 2006 at 10:14 am
I will be happy to argue against insurance companies making profit. How many low cost medications can we provide for the price of one insurance CEO’s multi-million dollar salary? How many people aren’t going to be able to get health care because insurance companies have made the practice of medicine so onerous that smart people don’t want to be doctors any more? The success of the country depends on a healthy work force, for profit insurance companies put barriers both practical and political in the way of keeping people healthy.
There is a bit in the Hitch-hikers Guide to the Galaxy about a group being “the first ones up against the wall when the revolution came.” For me this will be the insurance executives.
September 15th, 2006 at 2:47 pm
I am remaining Canadian, thank you very much!
This kind of grief for doctors and patients alike is definitely part of the why and wherefore.
September 15th, 2006 at 4:20 pm
I sometimes wonder whether medical insurance companies should be required to be run by registered doctors, the same way law firms have to be run by lawyers.
September 16th, 2006 at 1:40 am
I’m so glad to be Australian. Yes, we have a government board deciding what medications will be on the subsidised list, but they are qualified professionals. We do get new medications slower than Americans do, but that’s not always bad, there’s legal and approved methods available to import them privately, and our small population means that we probably would anyway. I pay a maximum of $29.70 a month for almost any medication; if I had a healthcare card (low income, disability, single parent, unemployed etc.) I would pay $4.70. It’s a damn good system.
September 16th, 2006 at 10:19 pm
My favorite part is there is hardly any way to tell what (besides generics) they will pay. I don’t have the time to stop and look up their website, and any written lists are likely to change without notice. I wish they could get together and make a download for my palm pilot; the only one I get on my epocrates program is Cigna, which has few patients in this area (and fewer doctors).
September 16th, 2006 at 11:21 pm
Its ridiculous that we have 100 trillion dollars a year to fight in Iraq but can’t afford to socialize our health care system. Its a disgrace to humanity that we make doctors go through licensing exams but allow the people who make the final decision attend only a part-time MBA program (if that). To me, it never made any sense that you can allow a corporation to profit off the death of others. The HMO’s charge you monthly and then 20 years later when you get sick they just deny treatment. The only difference between the HMO companies and HItler is that the HMO’s take your money from you on a monthly basis and then kill you. I would love to see the american health care system overthrown. However, I must also say that the doctors are somewhat to blame. They got greedy and stabbed each other in the back. If no doctor signed those contracts with HMO’s youd all be in a better position right now. What idiot would sign a contract saying “we’ll give you a patient, we pay you an eight of what you normally charge, we make you our bitch and you do what we say, and you still maintain all the liability and expenses associated with what you do”? All the doctors saw that contract and said “Great! where do I sign?” The HMO’s are disgusting and the CEO’s ought to be publcly hung, but the doctors also sold eachother out, and now you’re paying bigtime.
September 18th, 2006 at 5:02 am
Evan… it isn’t that we can’t afford to socialize our healthcare system.
It’s that a lot of people don’t want our government to socialize the healthcare system. Frankly there is nothing to be ashamed of in the instances of not wanting to socialize anything.
The last time a universal healtch care system was seriously tried in this country was during the Clinton Administration. It didn’t fall through for lack of money.
It fell through because it’s too damn complicated.
Of course, money aside, I don’t think we can afford to socialize our healthcare system. I have no idea how many qualified, hard-working, non-bastard, genuinely caring MDs we have in this country, but with a population of 300 million people and growing I don’t want to be part of the data entry team responsibile for filling out the universal healtcare computer system. Nor do I wish to be in-between prescriptions at the moment of the great system change-over.
Nor do I wish to trust my health needs to a federal government that until five years ago didn’t have allowances for protective agencies to share informtation. Nor do I wish to trust my health needs to a government that could not effectively handle hurricane relief where responsible as well successfully stave off blame where it wasn’t responsible. For goodness’ sake! The fed. screwed up where it shouldn’t, where it had responsiblity have while simultaneously taking the blame for city issues and state government issues. and it had money to burn for hurricane relief! It gave away debit cards to people!
Where was I? oh right.
I hate the whole insurance company need deal, but as far as I am concerned my drug isn’t getting any more genericized and I can’t afford it without insurance. So I’ll go for an insurance company paying the big load, I pay a co-pay and the system is working. Let’s not aggravate the dots. Let’s not mess with the system. For me it’s working. If I find out that it’s socialized in three weeks and suddenly my prescriptions don’t work… who am I supposed to blame, the government?
Good luck holding the federal government for frakking up an individual prescription.
September 18th, 2006 at 8:20 pm
I just wish my family and I had health insurance.
March 26th, 2008 at 2:27 pm
I am a mental health provider who just typed in the google search bar “Health Insurance Companies are the bane of my existence” and this is where it sent me. I am not at all surprised at what the good doctor is enduring for the sake of taking care of his patients. At a time in our society when there are more random and not so random shootings at schools, colleges, places of business and neighborhoods, when the economy is in the tank, when our property values are declining, when we are losing our jobs and when gas prices are expected to reach $4.00/gallon, when we need mental health services more than ever before, the insurance companies are running us out of business. I spend hours at a time to collect for an hour’s worth of work. The insurance companies lie, deny claims for lack of authorization (I have one), exceeded authorized visits, (I didn’t really), exceeded the end date (they didn’t tell me there was an end date), the word “None” wasn’t centered in the box on the HCFA form so the computer kicked it back and on and on and on. Today I had 13 sessions denied for payment from just one insurance company. This is not unusual. The insurance companies cannot get my tax id number right for 6 years in a row and then send me a threatening letter that I can be fined and sent to jail for providing the wrong information. (I sent certified letters, emails, faxes and made numerous calls over the six years to get the thing corrected.) Today I was told that I had used 4 sessions on an authorization made for February 1. I said no, I had used one. Then the person on the other end of the phone said, oh, they used those authroizations on sessions that happend last year. I already had authorization for last years sessions, last year. If she hadn’t admitted that to me I would have appealed the denial for payment and lost the appeal without ever knowing that they applied last years sessions to this years authorizations. Since I went into private practice in 1989 my income has declined while my costs have skyrocketed. I had a secretary and phone in 1989 which I shared with the other therapysts in my office. Today I have 7 computers, 4 employees, 3 fax machines, 2 copiers, email, internet, and more and I can’t get the damn insurance companies to pay me what I have rightfully earned. Today when I get calls from college students wanting to go into psychology, I tell them don’t do it. I love working with patients and seeing people’s lives improve but I can’t make a decent living doing it and I think I could find something else i loved that I could actually get paid to do.
Just sign me, FED UP!
By the way, I would love to work for the government, get sick leave, paid holidays, a retirement package, salary etc. Socialized Medicine? Bring it on!
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