Blog | Wednesday, March 27, 2013

Do insurance companies want you dead?


ATTENTION: Your patient's request for the following medication has been denied. A licensed clinical pharmacist has reviewed your prior authorization request. Your prior authorization request has been denied.

Me to favorite nurse: "Can you call this company and find out what's up? Who is this pharmacist denying my patient an effective, inexpensive drug he's been on for years? Can you please get them on the phone?"

A few hours later ...

Nurse: "They said that you cannot call to speak to the pharmacist. He will call back if and when he feels like it."

Me: [redacted]

NEXT DAY

"Hi, my name is DrPal and I'm calling on behalf of my patient Mr. [...] whose medication is being denied."

Drone on phone: "Do you have his plan number?"

Me: "No, but I have the name and date of birth."

Drone: "Can you give me the social security number?"

Me: "No, we're not allowed to collect and keep that information."

Drone: "Can you give me the name and date of birth?"

Me: "Yes!"

... Beethoven piano concerto on hold. Not bad ...

... Second movement starting ...

Drone: "The medication was denied."

Me: "Yes, we stipulated that. Why?"

Drone: "Have you tried Medicine A?"

Me: "That wouldn't be appropriate due to his other medical problems."

Drone: "What about Medicine B?"

Me: "That isn't used to treat the condition in question. At all. Ever."

Drone: "Sir, I'm trying to help you."

Me: "You could help by giving my patient the medicine he's been on for years. Who is this pharmacist who hasn't seen the patient? What do they know about my patient?"

Drone: "Sir, I'm just a third party."

Me: "Does that mean he can't sue you when he suffers a problem from his lack of medication?"

Drone: "Please hold"

... First movement of concerto begins ...

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.