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It’s enough to make anyone grumpy

I no longer remember to which kind blog I owe the enormous boon of finding Dr. Grumpy. At least once a day, sometimes oftener, his comments on life, neurology, and everything are laugh out loud funny. Today he’s on about insurance companies (go read the whole thing, it’s impossible to do it justice) and he manages to make even that funny. He needs to start a blog on death and taxes.

Doctor Grumpy in the House: Annie’s Song

If you don’t want bureaucrats between you and your doctor- TOO BAD. They’ve been there for years. THE ONLY PEOPLE WHO DON’T HAVE THIS PROBLEM ARE PAYING CASH FOR EVERYTHING! …

So what happens to you the way it works NOW, with your non-government insurance?

You come to me for some neurological issue, which requires further work-up. So I order, say, an MRI and MRA of your head.

Annie gets the order, and calls Bozo Insurance, Inc. (BII) to schedule it. BII refuses, saying they want more information. So they fax us a 5 page “pre-auth” form, which Annie spends 20 minutes filling out and faxes back. Then they say the form wasn’t enough, and they also want copies of your office notes, so we send those, too (yup, when you joined BII you agreed that they can read your medical records).

[A] few days go by. BII will claim they never got our fax. Or that we filled the form out wrong. Or that they don’t cover Capricorns when the moon is in Pisces. And we don’t know this until Annie calls back after a few days, because they’re hoping we forgot about it.

Eventually they’ll deny the whole thing, on the grounds that you don’t meet criteria for an MRI and MRA. …

[T]hey tell me I can appeal this via “peer-to-peer” review. Which means I need to personally call their “physician reviewer” to argue with them as to why I want the study.

So, during my insanely busy day at the office I have to call them. I’m promptly put on hold for 10 minutes, before finally reaching the reviewer. This person is a doctor- but NOT necessarily in my specialty. [And so it goes. Dr. Grumpy is an artist, so the story has an ending, but in the real world there is none. It just goes on and on.] …

So how did I get on this tangent? Because yesterday I was walking by Annie’s office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.

Annie: “I’m calling because you people denied an MRI on a stroke patient?”

Pinhead: “Before we discuss this, I have to inform you that this is a recorded line.”

Annie: “Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn’t happened.”

Pinhead: “Let me look up the tracking number… Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call.”

Annie: “Oh, now THAT’s a surprise.”

Pinhead: “What do you mean?”

Annie: “Is this line really being recorded?”

Pinhead: “Yes. It’s to improve customer satisfaction.”

Annie: “Oh, goody, because I’m sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review.”

Pinhead: “We do this to save our customers money on unnecessary testing.”

It goes downhill from there, but at least you’re laughing all the way. That’s also not like real life.

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19 Responses

  1. Dr. Grumpy is great!! Thanks for turning us on to this fine blog.

  2. You shoulda left in the part where Annie proposes that BII should save money by firing Pinhead.

  3. Does anyone else get co-pay envy? I was at the doc’s earlier and overhead the receptionist ask another patient fo rhsi $10 co-pay. I was all like “I remember when I had $10 co-pays — those were the days …”

    • I remember $5 co-pays. That’s how much I paid the hospital when my 2nd child was born.

    • My co pay is up to $20 now. Going to the ER only costs me $5 more. It’s positively baffling(since the used to cost $50 and you’d think they’d discourage ER use). Our specialty visits went up too. They are $35 a visit.

  4. Did ya’llsee this? Ouch…

    Obama the impotent

    The disappointment with Barack Obama is tangible – on climate change and financial reform Europe leads while the US lags

    http://www.guardian.co.uk/commentisfree/cifamerica/2009/sep/22/obama-un-climate-change-europe

    • wow, that was quite a read!

    • The wierd thing is that he seems to think that Obama does not have a filibuster proof majority in the Senate. He must have been told that by someone.

      For example, thwarting Obama on a regular basis is an unrepresentative senate where “minority rule” prevails and undermines what a majority of the country may want.
      snip
      producing what one political analyst has called “a weighted vote for small-town whites in pickup trucks with gun racks.”

      Apart from that, I remember the Danish organizer for the Copenhagen meeting, admitting, when pushed to BBC’s hardtalk, about a year and a half ago, that as a candidate she preferred McCain, who had actually been to Denmark with other Senators on a fact finding mission to control the melting of glacier ice in Northern Europe.

      Knowing Obama’s character-could that be why he’s snubbing her and sending Michelle?

    • I’m waiting to see what happens when the Dems in Congress realize that doing BigO’s bidding means they’ll never win another election in their lifetimes. I expect weeping and wailing and gnashing of teeth.

  5. Read some of Dr. Grumpy’s older posts for a good laugh. He blogs about their family vacations and they’re always good. I found his blog about 4 months ago and never miss it.

  6. OT — Massachusetts passes bill allowing governor to appoint successor to Kennedy:

    http://www.boston.com/news/local/breaking_news/2009/09/state_senate_de_1.html

  7. Wow. That scenario sounds like my daily life. I am still waiting for a prior authorization for a medication that a patient received earlier in the year, and needs to restart. I sent the first request last week. Since I didn’t hear anything, I called today, and of course, there was no record of the request being made. Yes, I faxed the information a second time. For a different patient, I had to go through this rigamarole 3 times, over a course of 3 weeks. Unfortunately, this is not funny to me. The first patient that I mentioned, ended being hospitalized, because she was not able to start the proper medication. It is only going to get worse with the new health insurance reform What a nightmare!

    • When I read that I also forgot to laugh. My wife and I now owe thousands thanks to this kind of baloney. Had to have the MRI. Had to have the blood work done. Had to have the pictures taken of the eye. See, temporal arteritis is a terrible thing to get and diagnosing it isn’t cheap. Of course, big insurance doesn’t really care if your wife can see or not. They don’t care if it could be caused by a tumor. They just don’t care. Nothing funny about that. Health care is not something to make a profit from. I truly wish there was really a heaven and a hell that way those nimrods in the insurance business can take their rightful place in Dante’s inner circle of hell reserved for the most heinous.

    • I have to agree. None of this stuff is remotely funny in reality. Gallows humor, really.

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