Thursday, February 23, 2012

insurance insanity

dear insurer,
please do not send me a four page letter telling me that my patient's medication is no longer on your formulary and then NOT INCLUDE A LIST OF THE FREXING MEDICATIONS THAT ARE COVERED.  first of all, four pages?  i am weeping for the trees.  and second of all, no list of alternatives? how difficult could that be?  really.

Wednesday, February 22, 2012

asking the tough questions

so what does it say about me that someone googled 'ICD-9 code for farting' and got referred to my blog?

don't answer that.

guilty pleasures

i have just conducted a totally non-randomized, unblinded, no placebo-controlled study and and can confidently convey to you the astounding results:

context:  firm evidence is lacking regarding which magazines are most popular in patient exam rooms.

design:  observational trial in which i move the star magazine somewhere deep in the pile and wait for it to resurface

setting:  my exam room

participants:  unknowing patients

outcome measures:  number of visits until star magazine resurfaces at the top of the pile

results:  based on my meticulous observation, it takes on average 1.75 patient visits for star magazine to resurface.

conclusions:  we love our celebrity trash

i am submitting this to JAMA

Monday, February 20, 2012

getting political

did anyone hear the piece on NPR this morning about jehovah's witnesses claiming that allowing insurance companies to pay for blood transfusions was a denial of their religious freedom?

no?  you didn't hear that?

of course, you didn't.  that would be ridiculous.  there was no such report.

but just substitute rick santorum and birth control and then decide how ridiculous he sounds...

Wednesday, February 15, 2012

the masters of the form

the health insurance industry has long had a love affair with forms. (maybe you've filled one or two out yourself.)  the key purpose of the form is to allow them to contain costs improve patient care by carefully denying guiding physician's choices in the evaluation and treatment of the patient.

because i've filled out so many of these forms, i feel i have become sort of an expert and have some very solid advice to any up and coming insurance companies  looking to replicate this artform that has become the guiding beacon of the insurance industry.

here are my suggestions for how to create the most effective insurance form:

1)  for anything that might cost  more than ten dollars, require the doctor to fill out a form at least 2 pages in length.

2)  be sure to make the doctor include information that you already have, e.g. their insurance provider ID, a number you have assigned to them even though they already have a national provider number that was meant to replace the dozens of provider ID's that you are so fond of and that no one else cares about.

3)  choose a very small font size so the doctors (especially the forty year olds who have yet to admit they need reading glasses) really have to squint.

4)  ask for redundant information, e.g.  be sure to require that the doctor write his or her name at the top and the bottom of the form.  if you can request something be written a third time, by all means include that too.

5)  ask for ICD-9 codes.  this way, the doctor, or somebody in their office if they should be so lucky, will have to look up codes (also in a very small font size).

6)  ask questions that the doctor can't possibly answer, like 'will the patient need surgery in the next seven years?'  then be sure to put a correlating and menacing statement below the doctor's signature that says something like 'the above information is the absolute and entire truth now and in the future, and any misrepresentation on my part is punishable to the highest degree of the law.'

7)  whenever possible, request obscure chart minutia, eg 'list the prior medications attempted, with start and end dates and outcome of each therapy for the past ten years.' so that the physician will have to hunt through the chart cursing themselves for not documenting things more carefully.

8)  once you have mastered your own forms, hire another company to also inundate the doctor with forms.  be sure that the company has an infuriating name like 'Putting Patients First' or some other such nonsense so the doctor will be mad just having to say the name, as in 'hey laurie, could you please bring me the Putting Patient's First prior authorization form for triptans dosed biweekly on tuesdays and saturdays.  and be sure not to confuse it with the one for triptans dosed biweekly on mondays and fridays, thanks!'

9)  set up a schedule to change your forms slightly every 6 months so the doctor does not become too comfortable with them.  you do not want to foster any sense of familiarity in the physicians.

10)  and remember, even if the doctor successfully competes your form, you can always say you never got the fax.

(how do i put up with this, you may be wondering.  well, i sometimes inspire myself with small rebellions that allow me to believe that i am the master of the form.  (i can't rebel too much or then it just pisses off the patient that is relying on me to fill this form out for them). so i do things like entering the date as m/d/yy when they clearly indicate that i must enter it as mm/dd/yyyy, or if they ask for my name a second time, i write ' my name is still the same as it was at the top of the page.' we all must chose our battles.)

Tuesday, February 14, 2012

happy valentines day

my husband handed me a gift today, prompting me to grumble something about what a bum i was for forgetting about valentines day.  but then he told me that i shouldn't feel too bad because the gift he was giving me was actually a stocking stuffer he'd  forgotten about.  you can decide which of us is lamer.

Monday, February 6, 2012

i pass another test of my moral compass

my patient handed me his disability forms today and mumbled something like, 'i wouldn't want to ask you to lie for me or anything...'  (how's that for saying the exact oppposite of what you really mean?) 

i reassured him,  'don't worry, i won't.'

Wednesday, February 1, 2012

oh how they torture me

why is it that, when i have all the hospital records in front of me, and i ask the patient, ' how are you feeling since you've been home from the hospital?'  the patient immediately launches into a long and detailed accounting of how they were out shopping for a dress for their sister's granddaughter's eighth grade graduation party when they realized they just didn't feel right but they didn't want to leave until they had purchased a dress, but then their arm went numb so the clerk called 911... and so on and so on until eventually, now ten minutes into their fifteen minute appointment, i hear my self saying, 'so how are you feeling since you've been home from the hospital?'

we are very attached to our stories.  i am, too.