My husband has a history of sleep apnea and has had to use a CPAP for years. Recently, his doctor told him about an oral appliance you could use to replace it. Unfortunately, in order to get the insurance company to pay for it, he had to undergo a total of three sleep studies and other testing.
After the sleep studies qualified him for the device, he got a message from the pulmonologist's office saying that the insurance has denied the claim. When my husband asked for further information or to speak to the doctor, they said that the doctor didn't deal with insurance. End of story.
After a few more pissed off phone calls from my husband, the doctor agreed to write a letter to the insurance company on his behalf. But both of us got sort of irritated that the doctor clearly did the letter on a dictation program and didn't even bother to read it over:
Seriously, is this the way people practice medicine in this day and age?
Yes, this is the way people practice medicine, because the barrage of requests for letters of medical necessity, appeals of denials and other such letters to insurance already threatens to overwhelm my actual job of taking care of patients -- you know, actually using my clinical diagnosis skills, my communication skills with my patients, reading the literature and thinking about best practice treatments; and incidentally, the time that I get reimbursed for. So, no, I'm not going to dedicate the time to proofread my letter of medical necessity.ReplyDelete
Well, we had to ask him to rewrite the letter, so I'm not sure if it ended up saving him any time.Delete
I agree with LD here. I take time to proofread my dictations and notes but that always means more time away from my personal and sleep time. Some days the "just one more thing" threatens to break me. We don't get paid to do the vast majority of administrative tasks we must complete and we've been thrust into an adversarial relationship with the insurance companies. There was a time when paperwork costs were covered by visit reimbursement, but the volume of admin work has dramatically increased (quintupled?) in the last 10 years and reimbursements are down.Delete
This year we're getting unprecedented denials for medications like gabapentin(!!), generic Flexeril, and generic opioids which our patients have been on for years. I Do. Not. Have. Time. to pre-authorize gabapentin! We pay staff to help with that but I still need to write the medical necessity letters / note addenda to explain why a guy who has been taking gabapentin for 15 years and is not a candidate for other medications should get it. In addition, our staff literally spend 20-90 min on the phone (on hold, getting hung up on and calling yet again!) for each pre-auth task and there are only so many hours in the day.
Insurance doesn't want to cover physical therapy or procedures and now they don't want to cover basic cheap meds. I'm all for cost-conscious care, but there needs to be some nuance and blanket denial appears to be the current ins. co. approach.
... SOMEONE should be proof reading his letters, our dictation machines are typed by humans so this kinda stuff gets picked up.ReplyDelete
I agree. I was recently rereading a dictation I did, and I had to correct a mistake that would have affected patient care because the wrong medication was written in a discharge summary. They wrote a medication that sounded somewhat like what I wanted it to be. Could have been disastrous.Delete
I agree someone should proofread, but neither patients nor insurance wish to pay for extra staff or physician time. Nothing is free, folks, and all the costs of running a practice or hospital add up.Delete
Yep, this is how people, at least those in my neck of the woods, practice medicine today. To save money, our small in-house transcription unit was first downsized, mostly outsourced, and then replaced with a whiz-bang EMR system with speech recognition. In a group practice of 10 doctors only 1 has taken the time to train properly and can turn out near-perfect reports that only require minimal editing to put into final form. Unfortunately, he's the big boss and assumed his colleagues were being just as meticulous as he in his dictation habits. They're not, and their reports are going into the record looking much like the letter you posted. They are getting what they paid for.ReplyDelete
Pretty much get what you pay for. A lawyer writing the same letter would charge you about $300 and have his secretary do it.ReplyDelete
Wow! I feel for doctors too busy to edit their letters at all, but come on. At least give it a glance before pressing 'send'.ReplyDelete
I will make the observation that you live in the united statesReplyDelete
So far, we've been able to avoid the Speech (not VOICE!) recognition monster. My comment to the IT folks when they try to push it is simple: "When the CIO, the CFO, and the CTO use SR for their correspondence, I'll use it for my life-and-death radiology reports." No one has ever come up with a good retort.ReplyDelete