Sterile Water Irrigation Denied By Insurance. Patient Not Sterile Enough.

I feel bad for our patients.   Insurance economic algorithms are defining  the patient and doctor experience regardless of situations unique to the patient experience.  If our recommendations as physicians or your needs as a patient do not comply with your insurance company's economic algorithms, you and your  physician will likely get denial of care letters.  That means hours of headaches and delayed therapy for you and hours of headaches and uncompensated expenses for your physician's office in communication with your insurance company.  It is no wonder many offices have started charging patients for their busy work.  That denial of care can come in the way of preauthorization headaches.   I experienced that tragedy while trying to authorize a lidoderm patch for a patient of mine that was getting  great pain relief in the hospital.   That patient was denied coverage for the patch as an outpatient.   We too have experienced the frustration.  Mrs Happy was recently at Walmart.  She learned  our Blue Cross Blue Shield  insurance would not authorize coverage   on her medication refill required for our 9 week baby pregnancy related care last week because she was two days early to pick up the prescription..   That's right folks.  BCBS algorithms are denying care to our unborn baby because Mrs Happy is too compliant with her therapy. CMS would be thrilled at Mrs Happy's actions!...
Source: The Happy Hospitalist - Category: Internists and Doctors of Medicine Authors: Source Type: blogs