28 Minutes, 16 Seconds and Still Holding: Tales of a Family Doc

[kpete]

28 Minutes, 16 Seconds and Still Holding: Tales of a Family Doc
December 5, 2008, 1:09AM

I have to admit it. I'm feeling guilty.

In my last post I admitted that I had thrown in the towel. Rather than go to bat again for my patient whose medication had been denied by his new insurance company, I gave in and prescribed an alternative that might not work as well.

Well, today the guilt got me going so I re-read the two page denial letter. Again I found the words explaining the reasons for the denial, two of which amounted to advocating for unscientific medicine, even malpractice. And I found the additional sentence, buried about two thirds of the way down page two, which said that I could call the "800" number on the page to talk with the doctor who had reviewed the case and denied my prescription request.


There was no "800" number, but there was an "877". Same thing, I figured, so I called. Five minutes into the first hold, after the usual series of "if you are a virgo, push 1, an aquarius, push 2" I reached a human who asked me a series of questions about who I was, about my patient, his mother (really!), and then transferred me to another hold. Again a series of questions about my identity, a question (finally!) about the nature of my call, and (dashing my hopes), transfer again to another series of questions.

28 minutes, 16 seconds after dialing, the final question: Could I please leave my phone number and the best time for me to receive a call back from the culprit who denied my patient the medication which had controlled his symptoms for three years. It's now eight hours later, no call.

more at:
http://www.talkingpointsmemo.com/talk/blogs/doctoraaron/2008/12/28-minutes-16-seconds-and-stil.php#more
and:
http://www.dailykos.com/storyonly/2008/12/7/141324/053/160/670037

[annabanana]

1. This is ANOTHER reason why more & more Doctors are pushing

for the Single Payer plan..

It is beginning to look like any ohter "solutions" will just make things worse..

[ayeshahaqqiqa]

4. But the docs are also begging

that Obama listen to them and NOT the insurance/drug industries, who have dictated health policies for far too long.

[47of74]

2. The right rails against any attempt to fix this system

Because it'd mean their buddies in the insurance and pharmaceutical companies wouldn't be making the obscene profits they have these past few years. I look forward to the day President Barack Obama and our Democratic Congress deliver a major smack down to both.

[ayeshahaqqiqa]

3. Insurance companies practicing medicine

has got to stop. My doc has the same hassles. I know. I file the insurance claims for her. There is one large company that will no longer pay for a food allergy test. My doc is a specialist, and often gets folks who she suspects have major food allergies--she gives a diagnosis code for celiac disease, for example--but this certain company says too bad, the person can simply just continue to suffer because the company has decided that a food allergy test isn't necessary. Can't say the name of the company, but I will say I get Blue whenever I see their claim form crossing my desk.

[BrklynLiberal]

5. Big Pharma and Insurance Cos are the ones really fighting single payer health care.

Virtually everyone else is for it..

[McCamy Taylor]

6. True Story follows.

Had a patient, terminal lung cancer but otherwise fit, youngish (60s) mentally intact, with oxygen dependent COPD, her pulmonologist would periodically drain the pleural effusion that would keep her from breathing and which would have killed her pronto if untapped. After the effusion was drained she was ambulatory.

Her HMO had one of its doctors call me, tell me that they thought the pulmonolgist was wasting money with these procedures, she should be on hospice and be allowed to die. They wanted me to tell her that I did not like the care her pulmonologist was giving her and that I was changing her specialist.

I said I was happy with the care she was getting as was she. Suggested that if the HMO did not think that the procedures he was doing were medically necessary, they should refuse to pay. He said that they did not want to do that. They wanted me to represent their interests. I said (basically) "So you want me to lie for you and save you money without the patient knowing that is what going on." Then I hung up.

All insurance of all type is like this. All they care about is collecting premiums and avoiding payment of benefits. That is how for profit insurance works. Always! When the exclude drugs, they hope that the patient will pay for it out of pocket or (better yet) switch to another plan with a more liberal Rx benefit. Plans use the too many hassles tactic to drive away sick patients, especially if they are PPOs or are otherwise unable to exclude people with pre-existing conditions. We will be seeing this one a lot if privates get involved in universal health. It will be a hassle tour du force as they compete to see which plan can drive the most sick patients into the ranks of its competitors pool by having the most onerous hassles.

[truedelphi]

9. Thank you for being on the side of your patients. Many doctors get into burn out

QUite understandable, and then the insurance companies get what they want - the more limited treatment and lower cost care.

[IADEMO2004]

10. My son has had type 1 diabetes for 20 yrs. and I agree with every thing you said.

There is no place to low to go to squeeze a dollar out of people.

[dysfunctional press]

7. well- it is sunday....is that particular dr. on staff or on call today?

:shrug:

[kath]

8. GET INSURANCE COMPANIES OUT OF HEALTH CARE, NOW.

And yes, I'm screaming. The bloodsucking parasites have got to go.

FWIW, I'm a doc.

[dixiegrrrrl]

11. Every single comment and story on this page needs to be sent to Obama via

the "feedback" part of his website.
he is asking for feedback.
Give it to him.

change.gov

[glowing]

12. and my sis-n-law works prcessing claims that come in

The company bids for a contract for the army. They always bid too low so every year, they shed a few more jobs and they increase the case load. Then they are always months behind processing the claims, which means that dr's aren't getting paid.

[kath]

13. Kick. (already Recommended - would do again if I could)

Doctors and patients are so absofuckinlutely sick of this kind of crap. It's gotta stop.

Single payer. Now.
The US needs to join the rest of the developed world in treting health care as a RIGHT, not a privilege or a commodity to enrich the mega-wealth of greedy CEOs.