Dear health insurance company,
Let me set the scene for you. It was a sunny August afternoon. A young college woman with stars in her eyes and dreams of being a dentist came to my office. She drove an hour to see me and would leave the next day for college.
She was reasonably requesting that her implantable birth control be changed out so as to avoid pregnancy during her educational career. I reassured her that this would be no big deal, that my nurse would just quickly get it precertified by her insurance company (this is where you come in), and we could set up for the procedure which would be over quickly.
After about twenty minutes, I noticed the look of frustration on my nurse’s face, and asked her if the room was set up for the procedure. Imagine my astonishment when she informed me that your office was closed to precertifications on a random Tuesday.
Now I realize we live in Tennessee and that the third week in August is traditionally “Dead Elvis Week,” but I do not believe this to be a national holiday meritorious of your entire office shutting down without anyone available for even emergency precertifications.
Furthermore, my practice is required to provide emergency phone access twenty-four hours a day, seven days a week, including holidays. If we do not provide this, we can lose payments from insurance companies such as yours. How is it possible then, that you are not required to provide similar access?
Additionally, rumor has it that your establishment is pushing that even emergency rooms should have to call you to ask permission for procedures to see if you will allow them. What is going to happen to patients who have an emergency on a random Tuesday in August when their procedure cannot be validated? Maybe the emergency room can suggest that they have their illness at a time that is more convenient for you.
We were able to arrange for the young lady to see another doctor who performs this procedure in her college town; however, that appointment is several weeks away. I assume that you will gladly undertake the responsibility for any offspring conceived during the interval, if you are working the day she calls.
Kellie Wilding is a family physician.
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