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WHY MEDICAL STAFF GOES GREY

17 January 2003

It seemed so simple.  The patient needs a procedure for help with her pain.
It may or may not require removal of her ovaries depending on what happens
when they look inside.

First there's the complication of getting time in the operating room (when you are not on staff, you are low man on the totem pole).

Then you have to get prior authorization from Utilization Review at the patient's insurance company.

  1.. dial number
  2.. listen to long list of options
  3.. find the right option and press that
  4.. enter doctor's tax ID number
  5.. enter patient's insurance number
  6.. get switched to another set of options
  7.. enter patient's insurance number again
  8.. recording tells me the call may be monitored and that I'll be transferred
  9.. another recording tells me all operators are busy


Finally, after a very long wait, during which I have run around the office making Xerox copies for the next patient, changing the paper on the exam table, and starting to put a chart together, the agent comes on the phone.

I give the procedure code (everything you do has a number attached to it).  She asks me to hold.  Again.  I hold for a long time.  She finally comes back on the line.

"That procedure does not need a code," I am told.

Great!  That was easier than usual.

"It doesn't need prior authorization," I tell the patient, happily.

"Are you sure?" she asks ".because this is student insurance and I have to
get authorization for everything if it's not done on campus.

Sigh.

Back to the phones.  Repeat steps 1-9 again.

After a long wait I am told "if it doesn't need prior authorization, you need to talk to Customer Service to see if it's a covered benefit."

OK.  I call Customer Service.

Pretty much repeat steps 1-9 again.  Finally "Jeff" answers the phone.  He is
very nice.  "What is your procedure code?" he asks me.  I tell him.  

"That is an invalid procedure code," he tells me.  I wonder why they didn't
know that at Utilization Review, which I have already talked to twice.

He patiently sits there while I thumb through the massive CPT code book to
find the shiny new 2003 code.  I do this hoping that my questionable expertise has picked the right one, since Dr. G is busy talking with the patient about her surgery tomorrow, so I can't interrupt him to double check to make sure I've chosen the right code--and I sure don't want to hang up and call back again!

I give Jeff the code (later I find out from Dr. G that I had the right one-whew!).  He tells me that the information I received from Utilization Review is correct.  The procedure is covered and does not need prior authorization BUT, the bill has to be submitted to the university, not to the insurance company.

"HUH?"  I say--this is new to me!

He says that if I send the bill directly to the insurance company they will have to contact the university and get an authorization code from them to OK the procedure at a facility which is not on campus (the campus has no hospital).

My alternative is to call the university and get an authorization code.

I call the university.  Voice mail hell again.

Finally I am transferred to their insurance department and naturally the person who can give me the code is not there and I get an answering machine.

Surely there is a better way.  When you are Lord High Everything else (tho
Dr. G hired a janitor yesterday, so at least I'm not longer that), you simply can NOT spend 30 minutes on the telephone calling fourteen different people trying to get a simple NUMBER that will permit a patient to have a procedure that is going to relieve her pain!

The patient's pain may be relieved tomorrow, but I suspect my headache is
going to last for a very long time.

Quote of the Day

I have endeavored to show that there is no real service of humanity in the profession [of medicine] and that it is injurious to mankind.

~ Mahatma Gandhi

Today's Photo

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Does this look like a new home owner? Could be!  He and Laurel are checking escrow tomorrow!

One Year Ago
I Am Woman, Hear Me Scream
Today I was biller, bookkeeper, receptionist, appointment scheduler, surgery scheduler, physician assistant and should have been janitor, but it was 7 and I was too tired, so I came home.

Two Years Ago
Alphabet Soup
You just can’t imagine how jazzed I am to see those initials again popping up all over my office. We saw EV, JM, MM, MAD, and LMS at lunch the other day (BG was sick and couldn't come), and had dinner with LDS and RM. CLO was here for dinner last night.


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Pounds Lost:  74
(this figure is updated on Tuesdays)

On the Odometer

URL 733
Blue Angel 518.9

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Created 1/10/03

 

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