Sunday, March 3, 2019

Medical Practice Hassles Torture Patients and Doctors

We do most of our colonoscopies in our ambulatory surgery center (ASC), which is attached to our office.  We are proud of the work that we and our staff do every day and are grateful for the outstanding feedback that we consistently receive from our patients.  Some insurance companies will not cover procedures in our ASC so these patients must get ‘scoped’ at the hospital instead.  For many of them, this means required blood tests a few days in advance of the procedure, which we would not have required for an ASC procedure.   On the procedure day, the patient and the driver will enjoy spending hours in the hospital for parking, checking in, interviews with various medical personnel, the procedure and the recovery period.  And, since it is a hospital, delays are inevitable.  Not only does this experience take hours longer than it should, but we are mystified that an insurance company would take on the expense for a hospital test that we could do more efficiently and cheaper in our ASC.  Can you make sense out of this?

It is typical for a physician’s prescription for a patient to be ‘denied’ by an insurance company.  Such denials, of course, are never issued by a medical professional, but are form letters kicked out automatically if the physician’s preferred drug is not included in the insurance company’s sacred formulary.  Appealing a denial – which we will attempt – is just as smooth and stressless as calling the IRS for questions on your tax return.  It is designed this way so that physicians and patients simply give up.  What physician has the time or fortitude to make several phone calls to hear repeatedly, ‘please listen carefully as our options have changed…”  Sometimes, my recommended drug is denied because my patient has not first tried a different medication, which I did not prescribe because it is not indicated for my patient’s condition.  Should I prescribe the wrong drug so that few weeks later when it is not effective, I can then hope that the correct medicine will be approved?  Can you make sense out of this?



The System Can Make Doctors and Patients Batty


Some insurance companies will only permit me to prescribe a 30 day supply of a medication.  Some of these medicines need to be taken indefinitely.  Why should these patients have to make 12 stops to the pharmacy every year?  Why can’t I prescribe a 3 or 6 month supply?  Can you make sense out of this?

A patient comes to me for a screening colonoscopy.  His insurance company covers this preventive service.  I do the exam and find a polyp, which I remove.  This changes the definition of the procedure from screening to diagnostic.  Why does this matter?  Because the insurance company may require that the patient pay a greater share for a ‘diagnostic’ procedure?  In other words, the patient gets penalized because his gastroenterologist removed a polyp, which is the goal of a screening colonoscopy.  Can you make sense out of this?


If any reader can make any sense out of these real life medical absurdities, then the medical profession needs you STAT.  You are much smarter than we are.

1 comment:

Unknown said...

I am a bedside nurse and my hospital is self-insured, however they use a third party company to approve or deny coverage. I was denied a second visit to pain management for steroid injections into my lower back because they said I'd already had two visits. Our insurance does not allow employees to dispute these denials even though I pay my premiums (which aren't insignificant) through payroll deduction. My back pain is primarily due to activities related to my role as a bedside nurse. If I didn't work for the company but used their insurance, I would at least be able to dispute a denial. It seemed ridiculous that they would rather me not be able to do my job, which provides income to the hospital, than pay for a few milligrams of prednisone and lidocaine. You are correct that they know if they make the process difficult enough, people will just give up. It has me so frustrated that I'm considering seeking alternative employment.

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