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…..

Love and self

When you love someone, do you lose your self?

I think that is the tricky bit about love. When you fall for someone else, do you fall or do you hold on to yourself? Where is that boundary?

I am in a flirtation. I am very interested in a person. I am interested in what he says and what he is interested in. I am learning quite a bit about some topics that really, have not been on my radar. I also often disagree quite strongly in the realm of politics. And I don’t really care that our politics are just about opposite ends of the spectrum.

I am interested in where we meet and where we don’t meet. Where we agree and where we very strongly disagree and privately think that the other person needs their head examined. I am not falling too far into the “really this person thinks like I do, they just won’t admit it” trap. Well, perhaps I am. Perhaps that is what love is: when we project part of our self and the ideal part of ourself on to the other person. They reflect and occupy some part of our ideal. That does not mean that they ARE our ideal or that they ARE the projection.

In this particular flirtation, he does not seem interested in much of what I am interested in. Well, particularly poetry. Occasionally this bothers me but mostly I shake it off. I am hoping that I have reached the age and level of cynicism where I do not expect the other person to like everything I like, to agree with what I say, to have the same ideals or ideas. I am watching myself and wondering how much of what I like in him is him and how much is my projection. Don’t know yet. The mind is a peculiar place. So is the heart.

But …. I am feeling much happier about holding on to myself at the same time as I fall and crush. I look at what he likes and wants but I also hold what I like and want. I am trying to give them equal weight, the needs and wants and desires of the two people present.

Hold and fall, at the same time.

The picture is of an etching by my mother, Helen Burling Ottaway.

Shake it off.

Also published on everything2.com