Revolution in prior authorizations

I had a small one doc family practice clinic for ten years. Spent more time with patients. The trade off was that if they need a prior authorization, they had to come in for a visit. I would call the insurance company from the room face to face counselling and coordination of care and all that crap. This did a number of things:

1. I could bill for the time.

2. The patient saw how the insurance company treats us and our offices. The rep on the line would try to call me by my first name since doctors rarely call. I would say, “No, please call me Dr. Ottaway.”

3. The patients sometimes had called their insurances already and been told “Have your doctor call.” When I would call, the company rep would sometimes say, “We don’t cover that.” The patient would be outraged and say, “But I called YESTERDAY.” The rep would say, “I only talk to doctors. The part of the company that talks to patients is a different part.” The insurance companies can’t triangulate their way out of that.

4. I would end the call by saying, “This has been a face to face with the patient call, you have been on speaker phone and I am documenting the call and the time in the patient’s chart.” At first the calls took 25-30 minutes. Some companies apparently flagged me, and would say “Yes.” if I called, and get me off the phone as fast as possible. They really do not like it being documented in the chart.

5. Insurance companies sometimes drop patients on purpose because the person has gotten more expensive. I had a snow bird from Alaska whose insurance had dropped him. He said he’d paid on time. I said, come in if you want and I will call them. I spent 45 minutes on the phone where they made multiple excuses, lied (we can’t send you a copy of his insurance because we don’t have a fax after they’d said he was not allowed to leave Alaska and I said, “For how long? What do you mean? You don’t insure him if he’s out of the state? Send me a copy of his insurance contract!”) I finally realize that they have dropped him on purpose because he’s been diagnosed with diabetes. I say “Ok, look, I am staying on the phone until he’s reinstated and I don’t care how long it takes. And if you hang up on me I will contact the insurance commissioner in Alaska and Washington states.”

6. Patients are truly outraged at how a physician is treated when she calls an insurance company herself. I have to give my name, my NPI number, my address, my phone number, my fax number, the patient name, the patient address, the patient phone number the patient insurance number and sometimes have to do it every time someone transfers me. When they see me spend 25-30 minutes on the phone to get a prior auth, especially if it is refused, they are up in arms.

I think it would be truly revolutionary if every doc in the country called an insurance company with a patient in the room and documented the conversation in the chart. Wouldn’t that be fun?

Gonna be a revolution, yeah…..

Kite

K for the Blogging from A to Z Challenge.

“Let’s go fly a kite, up to the highest height
Let’s go fly a kite and send it soaring.”

Mary Poppins was a movie that scared me as a child and worried me a bit. We didn’t have a television until I was nine, and so movies were a bit overwhelming. Animated movies could be scary but were clearly not real. Oliver Twist was the first movie that I saw with real people and the scene where the villain is shot and his body swings back and forth on a rope gave me nightmares. Way too vivid.

Mary Poppins worried me in a number of scenes. I knew that the fierce women singing about “suffragettes” were important, but I did not know what a suffragette was. I was aware that there was some tension between men and women, but did not know why. I did not ask about it.

I also found the bank scene terrifying. The frightening old men, formally dressed and the very old man in the sterile bank setting, with him nearly slipping and falling on the floor. I did not trust any of them and hoped Micheal would not give them his money. I thought they were ganging up on Micheal. The topic of whether a bank can be trusted is timely over and over again: will our money be safe or are we being lied to and manipulated?

I found the scene up on the rooftops frightening but exhilarating. Here is light and air and birds and flight and a view of the world.

All of this sparked by the word kite….

Just, Justice, Juxtaposition

J in the Blogging from A to Z.

Just, Justice, Juxtaposition

It is funny

R says that I should not
associate with J
leave the wrong
impression
everyone watches
judges in a small town

I am committed
to J

J wants more
pushes

I can’t tell
if J thinks
I’m joking
or just
is pushing me
past my limits

I don’t know

but it is funny

because J and R
are alike
passionate
idealistic
madmen

ethical
committed

R does money
J does improv

yet alike

and R is the joker
and J is the taskmaster

and everyone
is not
what they seem

and my reputation
is shards
anyhow
in the surf
my X
told all
that I wasn’t
putting out

before
we were X

one
in the surf
was my office manager’s
daughter
and my office manager
asked me
next day
couldn’t
I control
the X

I laughed

someday
I want to bring
J to R
or
R to J
and watch

them
circle
like cats
antipathy
or recognize
the heart
that stands open

which is why
I love them both

previously published on everything2.com