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.
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.