The follies of health insurance preauthorization

A few weeks ago, I saw a patient some gastro issues. So far, nothing newsworthy here since I am a gastroenterologist. I ordered a CT scan colonography, a special CT scan that is designed to view the colon in detail. It’s the CT scan version of a colonoscopy. Why didn’t I simply perform a colonoscopy, which, unlike a CT scan, would contribute to my retirement fund? That’s an easy one. Care to take a guess? The patient refused to undergo a colonoscopy. The patient had no insurance, and I don’t work for free. The CT scan was a better tool than colonoscopy to explain her symptoms. I expect that my discerning readers can identify the correct choice. I ordered the CT scan, which the insurance company summarily denied. I called and spoke personally to the physician reviewer and explained my rationale, but his decision was immutable. I asked if there was additional recourse available to me, and he advised that I could request a peer-to-peer discussion, when I could discuss the case with another physician. I had this conversation today with a doctor, whom I suspect, doesn’t treat living, breathing patients anymore. I felt as if I was talking to a guy who was reading off insurance company cue cards. He projected less humanity than is present in the ubiquitous mechanical utterances of, “Your call is important to us. Please listen carefully as our menu options have changed …” Continue reading ... Your patients are rating you online: How to respond. Manage your online r...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Gastroenterology Source Type: blogs