Routine Miracles

Restoring faith and hope in medicine.

My Hell: The "Pre-Approval' Call from the Insurance Company

Private Insurance companies ration care

I feel defeated. With a name out of a Hollywood script, "MedCo" practices rationing in the name of the private insurance industry. I am teaching class and a "blocked call" comes. I answer (because the last time this happened a patient was having a stroke), and I remind myself that as a doctor, the call I don't pick up is the one that can hurt someone.

It is MedCo acting as a barrier to what my patient needs - again. In general, I am a huge fan of generic drugs, but sometimes only the brand name, and unfortunately higher-priced version, will do. MedCo is calling to ask for the "justification," also known as "Let's make it as difficult as possible for the doctor to prescribe this medication and we will save a few dollars."

I see myself as a Knight Hospitaler. The sick and the injured come to the hospital for protection, and it is my duty to get them what they need.

I brace for the call the same way I did as a child when my father was angry and he stood at a door demanding I pass through, and I swallowed the dread of whether he would swat me in the head as I passed. It does not matter that he never actually hit me. It is just the dread.

MedCo calling to remove 20 minutes of my life on hold, biopsying my brain with the pre-set list of questions, is like my father standing at the door. I swallow my fear and irritation and set about fighting for what my patient needs.

I triumph. I get the drug.

I also resolve to get the patient off the medication as soon as possible. I won the battle, MedCo wins the war. By throwing up a barrier, they have successfully rationed the care of the patient. 

What would you tell your patient?

a. "Hey Nick, let's switch your meds, this other stuff will be just as good for you," or,

b. "Hey Nick, I just can't stay on the phone for 20 minutes to get you this pill; it is torture. I have to get you on the cheaper drug so my life is not miserable."

Then I think about all the people who are panicked over the notion that "The Government Wants to Take Over your Medical Care" or '"The Government Wants to Ration Care."

Do you know which insurance company NEVER, NEVER makes these calls to torture me?

Medicaid and Medicare. The government programs. If you think government rations, while private insurers give, you are COMPLETELY WRONG!  It is quite the opposite.

 

 

Conrad Fischer, M.D., is a specialist in Internal Medicine and is the Director of Educational Development at the Jamaica Hospital Medical Center in NYC.

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