Blog | Thursday, February 22, 2018

As if I have nothing better to do

Ask most primary care physicians and they will probably tell you they waste a lot of time getting medications approved for their patients. I just dealt with this for one of my patients. He had been on it for four years, but they wanted some information from me. It seems they didn't trust my judgment and wanted recent lab work to confirm he wasn't taking too much, even though I had him on the lowest dose. The patient has insurance with Regence, and OptumRx manages the prescription benefit.

I called OptumRx and they first asked if I was a member or calling from a provider's office. Well if they had separate numbers for each they wouldn't have to waste time asking that question. Next they asked for my name and title. Then they asked for my NPI number. Once I gave it to them they looked up my name, so they could have skipped the question of my name and merely confirmed it after they had obtained it from the NPI number. Actually they should have already had my NPI number as it was attached to the prescription, that they paid for, and I'm sure is in their records already as they get that information when physicians apply to see (and bill) their patients.

Next they asked for the patient's member ID number. I told them I didn't have it, but I did have the reference number they gave when they asked for me to call. I was told they couldn't use that information, so they asked for the patient's name and date of birth. I gave it but the person couldn't find the patient in their system. So she then asked for that reference number. After a while she said that patient wasn't in the group she managed and she would have to pass me on to someone else.

The next person again asked some identifying information then wanted to know a test result the patient had, as well as the normal range for that test. I gave the three numbers and she said they would be in contact. Less than 30 minutes later it was approved, but that whole call took 9 minutes! That's an incredible waste of my time just to give three numbers. They could have just asked my nurse to give the lab results to them over the phone or fax it to them and not have wasted my time at all.

Besides the time I spent, there was also the time spent by a couple of staff members to get the message to me, and the subsequent fax confirming that it had been approved. We deal with lots of these things every day. If physicians were their paying customers, they'd be out of business with service like that.

Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington. This post originally appeared on his blog, World's Best Site.