P for prior authorization

The letter P and my theme is happy things. But what comes to mind are these P words: prior authorization,  pharmaceutical, payer.

Prior authorizations are NOT a happy thing. The latest twist from insurance companies, three different ones in the last week, is that they are requiring prior authorization for old inexpensive medicines. I ordered a muscle relaxant for night time only on Thursday last week for a person with a flare of back pain. Friday I was dismayed to see that the insurance company was requiring a prior authorization. I have to prioritize the order of urgency of all the work: I did not have time. I called the patient who had paid cash for it. The insurance company wins. They didn’t have to pay for a covered medicine because they made it difficult to get. They keep the patient’s money.

Prior authorizations are on the rise very rapidly. With over 800 insurance companies, each with a different website, each with multiple insurance “products”, no one can keep up with it. It is a shell game, the ball under the cup, three cups moving, but the ball is the money and it’s already palmed by the insurance companies. I predict that this will continue to get worse. We do need a single payer system for the simple reason that physicians will not be able to hire enough staff to learn and navigate 800 different websites. I do most prior authorizations on the phone in the room with the patient: the other day we spent 35 minutes on the phone only to have the insurance company say that we had called the wrong number. Call another one. Not the one on the insurance card. We could complain to the state insurance commissioner, but my patient is afraid of losing their insurance. Time’s up. The prior authorization is not obtained, and we are five minutes into the next patient’s visit. People are finding that the medicine they have taken for 20 years suddenly requires prior authorization.

And remember: prior authorization is your insurance company making rules and extra paperwork for your physician. It is advertised as a way to save money, but it costs YOU money. Back in 2009, the estimate was that physicians in the US had to spend 90,000$ per year EACH on employees to do prior authorizations by computer or phone. And YOUR insurance dollars go to the employees at the insurance company refusing medicines and dreaming up new medicines to refuse. They change the contract. Every year and during the year. The law is now that 80 cents of each dollar must go to healthcare, not profit, but those computer and phone employees are counted as healthcare. Do we really think that is healthcare?

Take CT scans. Medicare does NOT require prior authorization. But most insurance companies do. Think about that. Is age the difference? CT scans increase cancer risk over time so physicians don’t order them by reflex.

And for pharmaceuticals, insurance companies often have an on line formulary. But it is different for every insurance “product” in individual companies. A patient and I were trying to sort out a less expensive medicine on a website and we were having difficulty figuring out which insurance she had. Multiple abbreviations and color coding and we could spend the entire clinic visit just figuring it out. Is that what medicine is in the United States? You can say that someone else in the office could do it, but the more employees your physician hires, the less time the physician will spend with you, because he or she has to pay all of those people.

If there was one set of rules, one website, I would learn it. Medicare for all, single payer, when will the United States people wake up and tell congress: if you want our vote, make it so.

P

But wait, where are the happy things? I am so happy that I still am in business in my small clinic, p for patients and patience and prayer and single payer, we will have medicare for all in my lifetime. Whether I am still a practicing physician in the US at that time is uncertain. If I can’t afford my own health insurance, my clinic will close. Wouldn’t that be ironic?

 

Happy no

Name, noun, nut, gnome, know, no…

I have a nutty streak, a silly streak and love silly things. It helps me to balance clinic. Sometimes things are hard there, I hope to be able to do something for many people that I see. Half my patients are over 65, one is now 100, and no one lives forever even if I recommend the right things and they live a medically perfect life. I am always mourning for someone.

So my nutty streak comes out with listing words for the letter N and adding gnome and know. Are they N words or not? I think they are.

And my happy thing today is the word NO. How, you say, can NO be a happy thing?

This weekend I wanted to do too much. I wanted to attend a retreat about change that went from 9:30 to 3:00 but I also was already tired. It would be with a  group of people that I don’t know well, so my introvert side would be on guard. My son was coming into town and I needed to make choices and save energy and say no to myself. I went to the retreat, but only for two hours. I wanted to stay longer but did not. And that protected my energy for the next day and this busy week.

Do you argue with yourself and want to do too much or something your shouldn’t or spend too long on something that you didn’t plan to? Look, I thought this would be a very short post to catch up….

N

There were three great blue herons on the beach the other night, and then an eagle in the surf. The herons were fishing but also watching the nearby eagle, the people on the beach, loose dogs going by, and each other. Their feathers were windblown and they made me think of teens at a dance, looking at each other with interest, but pretending they were more interested in fishing.

Happy Blogging from A to Z!

 

Mundane Monday #156

Welcome to Mundane Monday #156: our theme today is serendipitous light. Does serendipitous light contradict mundane? I don’t think so. We were walking on the beach in the evening and as the angle of the light changed, Marrowstone Island lit up under the lowering clouds. I stopped taking pictures of the flock of brant and took pictures of the land and sky instead.

What picture do you have of serendipitous or accidental or fortuitous light? Link and I will post them next Monday.

Last Mundane Monday #155, the theme was close color.

The Wishing Well sends this: https://bedressed.wordpress.com/2018/04/12/photo-challenge-yesterdays-mundane-capture/.

And K. L.Allendorfer: https://klallendoerfer.wordpress.com/2018/04/09/mundane-monday-embassy-suites/.

Happy Monday and I hope that your sky and horizon light up more than once this week.

There, I managed to mess up links to #155 at least three times….learning.

 

one of these things

For the Daily Prompt: deplete.

Holy cats, am I feeling depleted! Since I got back from vacation, have worked every day including both days last weekend! Neck hurt this morning, all stiff, I need a day off! No medicine today…

And what repletes you? Walking outside and taking photographs repletes me: and wondering. The gull is hanging out with the whole flock of brant geese. They don’t seem to mind. Nice! Black and white together! And I think of Sesame Street: “One of these things is not like the other.” Really, when you get down to it, the brant each have their own individual characters too, right? Grouped by species or not.

And music and dance and singing replete me: here is a fabulous hour of boogie-woogie piano music with Daryl Davis and others. I danced to Daryl Davis in Maryland back in the 1980s! Go Daryl!!

jump, jive, joy

Blogging from A to Z, my theme is happy things. The letter J for jump, jive, joy!

And jitterbug! I am a jitterbug dancer, east coast swing or 6 count swing, and lindyhop, and west coast swing. Salsa, merengue, cajun dance, two step, oh and a few clogging steps, about 6 total. I love to dance and I love the Jump Blues!

I took the photograph this morning: of an old t-shirt. We went to as many dance camps of The Savoy Swings Again as we could. There were two bands and lessons all day and I would have to increase my salt intake to keep my muscles from cramping. Deanna Bogart is still playing. And the Washington Swing Dance Committee still has a page devoted to dance!

On my last trip to the Washington DC area, my daughter said, “Let’s go dancing.” We found the DCdancenet site. We found a contra dance at the Spanish Ballroom, at Glen Echo Park. My son, his girlfriend, my daughter and I all went to the dance. The Spanish Ballroom is where I met their father and living on the west coast, I had not been back for years!

Jump, jive, joy and jitterbug! I am glad that dance is still going on, teaching, live bands and all the joy it brings!

J

And check this out: the same t-shirt shows up in this video of the Jiving Lindy Hoppers!