Thursday, May 17, 2007

Feelings and Stuff

First, I want to share my feelings of the moment with you:

Sad: That Fat Doctor has closed her blog. I actually discuss her life with my husband as though she's a friend or family member.

Annoyed: That an insurance company can't process the claims for one of my patients until I fax them a copy of my medical license. No insurance company has ever wanted this before, Why exactly are they the only one that can't process claims without it. Not quite true: a few weeks ago, an insurance company mailed me a Letter to my office: they couldn't process claims without my address (!--where did they think they were mailing the letter?), a copy of my Tax ID number-- I don't believe I've ever had such a document-- and my license, however I believe this is the same insurance company that called today. How many hoops can they insist I jump through. Okay, okay, I faxed it, time to move on.

Tired: Long day of being mom and doc and still more to do. Currently, I'm procrastinating.

Thank you all for your votes and comments on the first chapter of Double Billing. It's still not too late to vote, I was hoping for 50 million responses and so far have gotten....ummm a little over 50.

Did you want the story of that chapter? When I wrote the book, I liked the first chapter a lot. I showed the book to an agent who said "No thanks," and I got a bit paralyzed. I decided to take a grad school course in the hopes of learning something about fiction writing and getting some constructive feedback. I had to apply to grad school, got accepted, took the course, got a huge amount out of it, reworked the beginning of the novel, and incorporated a bunch of the instructor's ideas, one of which was to have the intro chapter look like it was in third person but then have the narrator introduce herself into the story in this way that some of you described as "jarring." I liked it, he liked it. What's wrong with Jarring, anyway? If someone walks into a restaurant to unexpectedly find an identical twin, it might be, well, jarring. But okay, like it, don't like it, let me think about the commas, I am so fond of them.

So now I put up the original version of Chapter One on a new blog, Double Billing: The Interactive Novel. I'd love your vote. So far it's 6 unopposed votes for the original chapter.

As soon as I can get some traffic there, I'm going to stop hogging Shrink Rap for this (though I will post when the other blog is updated), and I'm going to put up the novel chapter by chapter for as long as anyone can stand it.

And ClinkShrink, thanks for your repeated concern, but I'm happy to have the feedback and my feelings just don't get hurt over this stuff. Carrie, that's for you, too!


Zoe Brain said...

You think you have problems jumping through hoops.....

Sorry to harp on in such a monomaniacal and obsessed way, but I doubt you have considered what those going through the recommended - and in some places legally mandated - path of Transition have to go through. It may make you feel better, and say "there for the grace of God go I" if I tell you.

First, you have to find some mental health care professional who knows something about it. The first time I saw my GP, she phoned around, and after 5 attempts, found a psychiatrist who'd never worked in the area, but was willing to have a go.

This did not inspire me with any great confidence. A bit like having a brain lesion of unknown origin, and my only option being an ENT specialist who wants to try neurosurgery.

In other states it's easier : there's legally mandated clinics, and you have no choice as to the therapist. They also have no choice - first a MMPT, then a 3 month period of observation. If no relationship of trust is formed, tough, they're the only game in town.

After finding someone, there comes a 3-month plus evaluation period. It's intended that that be to differentiate diagnoses - BPD has similar symptoms. I'm not psychiatrically trained, but I can easily imagine other disorders might cause the patient to show similar symptoms too.

After that, hormones may be authorised, but any good endocrinologist would only start with very low doses, gradually ramping up over 6 months, with constant blood testing.

This is also a great diagnostic tool - those who are merely crossdressers or transvestites tend to freak out when their capacity for male intercourse ceases, long before any permanent change, but I digress.

I have a friend who at the moment is doing all he can to convince a psychiatrist with no surgical experience that a particular surgeon in Serbia is adequate for his needs. Papers, publications, explanations of surgical procedures, statistics, photos of results, all have had no effect. No letter of surgical authorisation will be forthcoming unless one of two surgeons in the world is chosen - neither of whom uses a (pardon the pun) cutting edge technique.

Having Gatekeepers who can tell you which particular surgeon to see, how to dress, which films you are allowed to go to, what jobs you are allowed to take, if you are to be given permission to get further treatment is very vexing for many patients. Other therapists on the other hand allow rather more freedom, judging by results rather than micro-managing. It's the luck of the draw, really, and often there's no alternative.

I also know of cases where people have been kept "in therapy" for 10 years before finally being told that the therapist doesn't feel comfortable giving anyone letters of permission, even though the patient qualifies, and it would get peer-reviewed anyway. This can be extremely frustrating for someone with no co-morbidities, who is only "jumping through hoops" to satisfy the Standards of Care.

I also know of cases in the UK where if a patient is caught smoking, they are removed from the therapeutic system and told that no further treatment will be given. This has led to a couple of cases where non-smoking patients have been removed from treatment for being in a smoke-filled environment immediately before an appointment. Appeals are useless. To people already prone to depression and suicidal ideation, such treatment can be and has been fatal.

I was lucky, being endocrinally odd, everyone was too busy trying to get my therapeutic regime to approximate something known and safe than to worry too much about specifying which surgeon, and which exact surgical procedure, I would be authorised for. For one thing, my body wasn't exactly standard.

So my sympathies in dealing with mindless bureaucracy. Especially since it's really to help a patient, rather than yourself.

Gerbil said...

Dinah, you are not the first provider to be told--by mail--that your mailing address is needed to process claims. In the couple of months that I've been working for managed care, I've taken a couple of calls about this very thing. (Which I promptly transfer to the claims department.)

There's probably a very good reason that this happens--but since I don't know it, I just find it really funny.

Oh, and your Tax ID, if you are in private practice, is probably just your SSN.

(One thing I've learned from working for Big Insurance is that when I'm finally good and licensed, I am not going to take any!)

Dinah said...

Zoe Brain:
Oh my gosh! It took me roughly 4 minutes to locate and fax my license and it didn't entail the augmentation, creation, or removal of any body parts. My minor annoyance with some dumb insurance company doesn't compare to your years of soul-filled angst. But thanks for the dose of perspective.

Yes, I did know that my TIN is my SSN, and it's on my statements that patients submit as Physician Tax ID number. I just didn't know exactly what they'd want me to 'Copy' and send in. The SS Card issued to me at birth just didn't seem the thing to copy and submit. It feels a little personal.

Catherine said...

I feel you on the being tired, both as a mom and as a professional. Thank goodness for the weekend, yes?

Zoe Brain said...

Then again, compared to some, we both have it easy.
It's amazing how sometimes Love transcends the most enormous difficulties. I wish they made some sort of medal for such caregivers, I just wish there were more of them.

Gerbil said...

Dinah, isn't it obvious? Photocopy yourself and mail yourself to claims!

Sarebear said...

Dinah, this is on my list of things to "must do". I've just been trapped in an obsessive cycle this week that has had me doing the same thing for 8-15 hours a day for this last week, until 4 in the morning sometimes.

Like you want to know all that. So I've been, well, not all there/here.

(Good thing I finally meet my new iatrist for a 1.5 hour initial assessment a week from Tues. So on the 29th.)

Anyway. Look for me there soon!


Anonymous said...

Sara! I've been wondering where you were. Come give your opinion on Double Billing.

NeoNurseChic said...


I'm late saying this, but thanks for the bit at the end there. I started to feel bad when clink was saying how much she loved the commas and sentence structure on that first post - thinking that she was saying that so that you wouldn't feel badly about my criticism. But I'm glad to hear that you welcome the suggestions, and you're really into having the book on the web for interaction! That's really neat! I haven't commented on chapter 2 - had a busy weekend, but I read it, and I liked it a lot!!

Take care,
Carrie :)

DrivingMissMolly said...

Flea is also gone.
I'm sad.


PS Has anyone her from Foo?