Insurance denials: the law of the land

It all started out with Malaysian methimazole, and didn’t end until two highly trained medical professionals sat on opposite ends of a telephone call, scratching their heads and wondering how two digits being transposed could lead to so many problems. Those two transposed digits caused a thyroid uptake scan to become a bone marrow scan (whatever that is). But look at all it took to get there. Mystery illness, mystery medicine It started when a new patient came to see one of my colleagues with a mystery illness, and a medication in a pill bottle with a label in another language. After figuring out what this medicine was, my colleague planned a thoughtful, step-by-step, appropriate workup to figure out what was going on, how to best take care of this patient. At each step of the way, she was thwarted. Everything she ordered was being denied by the insurance company, and they demanded more and more documentation, ultimately requiring her to get on the phone to deal with this in person with a representative from the insurance company’s medical team. We all deal with this every day, we order a medication, a test, a procedure, and it gets denied, and then we have to work through a series of ever escalating efforts, each one more complicated and annoying, to get our patients the care we think they need. This is just more of the same, more of the ways we as healthcare providers have relinquished the control of the care we want to provide our patients to someone who really...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Primary Care Source Type: blogs