Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Friday, October 03, 2014
On Faxing Forms. May I Rant, please, Just a Little?
I'm trying to be more duckish, to let things roll off me and to slow life down, just a little. There are so many people with so many problems, and so many bad things going on in the world, it seems I shouldn't get bent out of shape about things that really don't matter.
Having said that, I snapped at someone today over one of those little things that just shouldn't matter: Getting pre-authorization for a medication for a patient.
First, let me say that some of this is my fault. I hate my fax machine and I just haven't bothered to replace it. It spams me with roofers and $99 Disney World offers, and repeat requests for medication refills when the patient long ago stopped taking the medicine. The memory empties if the machine gets turned off or the power blinks, and it often prints the same document repeatedly. It prints documents one at a time and I often need to stand over it to get them. The day I stood there waiting for it to print out 11 requests from the same pharmacy, for a refill for the same medication, I had a revelation: I could become a doctor who won't fax. I turned off the fax machine and it is no longer a part of my daily life. On rare occasions, when there is no option, I turn it on. But mostly it's been a big relief. Other people don't return phone calls. I don't fax. We can email pdf files, and if I need to get a document to a patient, I take a photo with my phone and text it to them. If that doesn't work, the phone has a scanner and I can email documents. Why would I need to stand over a fax machine? It's also my fault because I don't have a secretary to do these things for me, but that would come with it's own set of things to take care of.
So today I got a call from a pharmacy. I wrote for a high dose of a medication, it needs preauthorization. I'd need to call an 800 number to get that preauthorization. They forgot to leave the patient's insurance number. I called back, got the insurance ID #, then called the insurance company and began the arduous process of voicemail menu hell to get the right authorization form. Somehow, I was led to a live person, who kindly offered to do the pre-authorization over the phone, but then said it couldn't be done for this medication. It had to be faxed. They'd fax the form, I'd fill it out and fax it back. There were no options.
I went to the dreaded fax machine, during which time the insurance company put me on hold. I waited. Then I waited for the fax and it didn't come. She tried again and it still didn't come. I figured my machine just wasn't working and I asked if they could email it to me. They can't. Why? It has patient information on it, sending it on email would be a HIPAA violation. I asked about sending the blank form that I could fill out (I now had the insurance ID number). They don't do that. It's a HIPAA violation to send email, but faxes to a office where who-knows-who might see it, or wrong numbers might get dialed, or the wrong doctor with the same name could get sent the information (..with my last name, I get other people's faxes), happen all the time. I asked if the blank form was on a website. It was and she gave me the insurance company's general website. I knew -- from previous experience-- that I'd never be able to find it from there and asked for the exact URL. She couldn't give me that and instead offered to give me another 800 phone number where I could call to ask for the URL of the form. We were at 20 minutes of this -- in a time where there is no excuse for not being able to easily transmit a form to someone -- and I snapped at her and hung up. I'd deal with it on Monday. And then, of course, the form came through.
The form was already filled out. There were check boxes for the indications why one might need a higher dose. I check one. There was a question about whether a specific other medication had been tried. It had been, do I checked yes. And I faxed it back. Two check marks -- now why couldn't they take this information over the phone? Or why couldn't the form automatically have been sent to me when the patient handed in the prescription, without the pharmacy intervening to call me to tell me I had to call the insurance company to request the form be faxed to me? Oh, never mind, that would not have worked because my machine was off.
I suppose it bothers me because it feels like an unnecessary waste of time that is purposely engineered to be that way.
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That is after all the goal of prior authorization - along with getting you to work for free for at least 20 minutes per call.
I agree, Dinah. I have often wondered if insurance companies have secret departments that devise ways to slow down approvals, find problems in submitted claims, ask for additional information, all for the purpose of delaying or preventing reimbursement, but cloaking it in "quality." The more hurdles doctors and patients must go over, the greater the number who give up trying. For any given company this is a huge financial gain.
I definitely felt this was going on with my insurance company. I finally got so fed up that I googled the name of the President and email address and sent him my complaint. Next day, I got a call from the assistant stating my claim would be paid after I had previously made 3 calls to no avail. Haven't had a problem with payment since that time.
Joel, without "evil" Obamacare, I would be up shit's creek now that I have been diagnosed with sleep apnea. Do you really want to go back to the old days where people can't get insurance with chronic conditions like that? Would you want your patients to be in that position?
Yeah, I get that the requirements are horrific for physicians. After my hassles, I can't imagine how you all deal with this BS all the time.
But in my opinion, that would have happened whether Obamacare came along or not because insurance companies are simply idiotic in nature and have never been known for their common sense. I feel their motive has always been to deny payments whenever possible.
Unless your contract with the payer obligates, you do not have to fill out a form. You must, however, provide the medical record if requested by the patient. I charge the patient $50 for each prior auth. Prior auth is for payment. Payment is never a medical emergency. Docs who cave in and perform this service for free enable it to continue and reinforce the expectation that we should all do this.
Charge the patient.
I totally think it is purposely difficult. They are hoping you'll give up and it will save them money.
My daughter was prescribed an extremely small dose of generic Zoloft about 5 months ago. The paperwork, phone calls and faxes that had to be exchanged between myself, her doctor's office, the pharmacy and the insurance company were beyond ridiculous. Eventually I did give up and said that it just wasn't worth it. So instead of getting the medication approved by her insurance company and only costing me $5/month I'm paying out of pocket $29/month. Ultimately it isn't an expensive medication and dealing with the insurance company was threatening what little sanity I still have. They win. Nicely played insurance company, nicely played.
I'm sure everyone has insurance horror stories, and I have a memorable one. Blue Cross once rejected a claim to my dermatologist, because they said folliculitis did not exist. I said what do you mean it doesn't exist. The customer service rep actually told me that folliculitis is not a legitimate diagnosis. I said it most certainly is, and that I'm pretty sure the dermatologist didn't inject medication into my body just for the hell of it. I told her to google it, and she could read all about it.
Well, we don't have a code for folliculitis, she told me. I told her I recommended that she find the code, because I was going to call her every single day until they resolved it. That seemed to do the trick, and they did amazingly find a code. Imagine that.
If I had to deal with insurance every day, I think I would end up with a benzo addiction.
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