I was recently advocating for a young patient who had been hit by a car to get more time in rehab. I was talking to the insurance company, and the second I got on the line, it was really clear they didn't want to hear anything I had to say. (Honestly, does it EVER work to advocate on the phone? Because whenever I talk to anyone, they already know everything in the notes, and they've already decided on a hard no. And repeating my arguments just ends up with a heated discussion.)
In this case, it was especially frustrating because the patient was, as I said, fairly young and really could have benefited from the extra time. I said to the reviewer, "It's really a shame he can't get more time because if he had another week, he could get home independently."
The response of the reviewer: "Well, it was a shame he got hit by a car."
I mean, what do you SAY to something like that? Sometimes I want to say to them that I hope they have a better insurance than the company they work for.
So I just say that. I am ruthless and mean with insurance doctors(or more commonly my 'peer' in the 'peer to peer' review is actually a nurse). I lecture them. Suggest they need to review basic physiology. Rag them worse than I ever got as a medical student. Sometimes it works, usually it doesn't. But I used to be nice and it didn't work either. So now I at least get some catharsis. And if they quit, all the better. Their job shouldn't exist.ReplyDelete
Try being a nurse practitioner. Once I have to do a "peer-to-peer", it's already over. I work in pediatrics and the last time I did one, the internal medicine physician was already done. Like she knows anything about peds beyond what she learned in medical school. It's so messed up.ReplyDelete
"Yes, it is a pity, and here we are able to do something for this patient. Like making sure he gets the extra time he needs in rehab"ReplyDelete
Try saying: I will document that I feel it is absolutely necessary and in the best interest of the child to have an additional week in rehab. Then I will document that the insurance specifically refused to authorize it. You know just in case his parents decide legal action is required in the future when he continues to be dependent on others for his care.ReplyDelete