“Beep,” went the machine.
I left a message and hung up.
My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year.
I was leaving a message on his behalf.
You can be assured that if you hand an insurance card to the front desk employee at your doctor’s office, your doctor deals with health insurers every day. It’s the system we’ve come to expect for both the extreme and the routine in our medical care.
Most of us dislike it.
But, we’ve been taught we can’t afford it any other way. The cruel paradox, of course, is that the majority of us are being out-priced by the status quo.
Mr. G’s medicine was working fine. It’s the only one of its type that he has tolerated without side effects. The insurance company covered it last year. They changed their mind about it this year. And, until we accept the logic that entrusting third parties to pay for our health might be harmful to our health, they will be the ones who keep getting to decide.
I was told I could appeal the decision waged upon Mr. G by getting in touch with a “doctor”working for the insurance company.
If you read that again, it’s an unbelievably humorous statement.
Physicians, scientists, and researchers are routinely condemned by the most virtuous of stone throwers for having even the slightest lean toward a conflict of interest. Yet, having me appeal your insurance case to someone who works for the insurance company remains noticeably absent from their aim.
It is perhaps medicine’s greatest misnomer, the “peer-to-peer” discussion. This is what frequently must take place between your doctor and someone employed by the insurance company.
Today, it wasn’t even a discussion. It was just a beep.
I called the “direct” number I had been given. It was the “back line” that would connect me to an individual “right away.” I had even been given the full name of some (evidently imaginary) individual who would be awaiting my call.
But, the line just went beep.
The machine message wanted all kinds of information. My tax identification number, private knowledge about the patient, how I can be reached, when I can be reached, and so on.
I’m not sure why I bothered talking to it. No “peer” has yet to call me back. My patient remains without his medication.
I left myself a note on my desk to remind me to retry the charade tomorrow. I don’t easily give up. I have a few other similar notes on my desk now.
To be fair, I do receive calls from insurers from time to time.
In fact, Ms. J phoned me last week. She works for one of them. She had an intriguing job title. I wrote it down: “Provider data validation learning facilitator.” That’s really what it was. I’m not making it up.
She audits my medical notes from time to time. She combs through each word.
If I don’t have enough “buzzwords” in my note to get her attention, I don’t pass her audit.
Evidently, I scored too low this time. Ms. J called to setup a visit for her team to fly down on a plane (yes, four states removed) and meet with me in my office. Ms. J flies all over the country doing this type of thing. I kind of wonder if she flies first class.
The irony is that I’m a really good documenter. My work will back up this claim.
Granted, 95 percent of what I document in the medical chart is either inefficient or a complete waste of time. Every doctor knows this.
I’m not certain what year in the future our central authority has targeted to fix this problem. I just know their last $30 billion tax-payer funded investment made it worse.
I requested a copy of Ms. J’s audit and spent most of the afternoon reviewing it. Her and her team were tasked with determining whether the diagnoses I gave to my patients were accurate and supported by “words” contained within my note.
I started at the top.
Ms. J’s audit said a billing claim for one of my patients included “atrial fibrillation” as a diagnosis. Ms. J told me this diagnosis was not supported in my note. So, I looked at it.
My note’s first page plainly reads, “[The patient] has a history of atrial fibrillation.” Then, I go on to mention what I’m doing about it.
I’m not sure what other words Ms. J wanted me to use. Did she read my note? This cipher game — masquerading as medicine — has just become so mind-boggling.
I proceeded to review the audit’s second line item, and then the third, and so forth. With each one, the report would claim that a diagnosis was not documented in my note, and then, my note would go on to confirm why this diagnosis was present. I stopped after reviewing the eleventh item.
When Ms. J called me back, I told her that my next business endeavor would be to design a company that would audit the quality of her audits.
I don’t think she got my joke.
The interference within health care now is mesmerizing. Third parties won’t call me back about Mr. G’s needed medication, but they’ll gladly fly first class to see me to discuss my medical documentation.
We’ve completely lost our way.
And, yet, we seem poised to remain in our current state for the foreseeable future. Because we only see what they want us to see — that we can’t pay for anything without them. That we need them. So, we create laws that mandate we use them.
And then, we continue to support one regulatory web on top of another — always pitched in the name of safety — in search of the ever-allusive affordability that only comes from real money prices, established by extremely narrow margins, determined by a real market.
In summary, we pay for insurance. We pay for a multitude of third party moochers. We pay for an excessive bureaucracy to create regulatory barriers that ironically only the elite can navigable.
We do not pay for health care.
You don’t have to agree with Thomas Sowell’s politics to appreciate the logic of his words:
It is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer it.
Trillions of tax-funded dollars — allocated predominantly through corporate-influenced political means — are subsidizing more and more things you don’t value and interfering with good doctoring in the process.
Our mandated contributions — just review your insurance premiums for next year — keep going up.
Rocky Bilhartz is a cardiologist and the author of Finding Truth in Transparency: Our Broken Healthcare System and How We Can Heal It. He can be reached at BilhartzMD.com.
Image credit: Shutterstock.com