Monday, April 17, 2017


Last week I got a letter from an insurance company about a patient's medication. No biggie. Happens a lot.

The letter said my patient's prescription authorization was expiring next month, and that I needed to fill out and resubmit the forms to get it covered for another year. Okay, I do that a lot, too.

But this letter, in the interest of protecting patient privacy, didn't give me their name. Or the medication. Or their diagnosis. Not even an ID number or birthday. Zilch. Zip. Nada.

In fact, across the top of the letter it said:

And I must admit they were right. The only name on the letter was my own.

So what am I supposed to do? I want to help the patient, but a quick look at my computer says I currently have 1,043 active patients. At least 278 of them are on a medication that requires me to re-authorize once a year. I can't start calling all of them, either. Ones who are coming due in the next 2 months? 44 per my machine. That's still too many for a random guess.

No easy answer here.

Sadly, the way these things usually play out is I'll only know who it is because they go for a refill and are told the medication is no longer covered because uncaring Dr. Grumpy never bothered to do the authorization. So they call and yell at me because they're not going to get their medication "AND IT'S ALL YOUR FAULT!" (my kids love that line, too).

I'm a big believer in patient privacy. I work hard to protect it. But when information about a patient, and a potentially life-saving medication for them, is kept secret from the very doctor who's prescribing it... We've reached a new level of insanity.

Franz Kafka (not my patient)


jimbo26 said...

Dear Insurance Company ,

Yours faithfully ,
Dr Grumpy .

KJL said...

If only I didn't see "a new level of insanity" almost every day - many related to EMR and most of the rest to insurance companies.

Anonymous said...

From a pharmacy stand point, we're typically in the dark too. We don't know a prior authorization is expired until we submit a claim. Hopefully, if you get a request for a med you haven't recently prescribed for Mr E, there's a good chance that's what the "mystery medication" was.

Old RPh said...

Don't worry Dr G.
I'll let you know who the patient is and what prescription they need - after the patient SCREAMS and SWEARS at me in the pharmacy later this month.

Stacey Gordon said...

Glad you posted Kafka's picture... I was going to suggest it...

Anonymous said...

Incidentally, Kafka's day job was at an insurance company. Really.

Bob Culp said...

Crazy Rx Man will advise on everything.
That's hilarious about Kafka.

Mage said...

Amazingly awful.

FrankC said...

I think that Insurance Co. should ask the patient to contact you. This should (with luck and a following breeze) let you fill in the form, as long as Ins.Co. feels able to tell the patient that you are the doctor of record.
Does this make sense to you?
Me neither.

Anonymous said...

It's supposed to be easier, I think, if you as a physician, or a pharmacist, or a nurse, etc. are the patient, right? You know what the problem is, who to contact to make it right, and how long it will take, right? That would be a wrongo on all four counts. It's doubly, maddeningly frustrating, when YOU know what should BE. And, we wonder how our patients manage.

Anonymous said...

For a small hospital pharmacy, we get faxes every day, night and day, from insurance companies, authorizing or not the permission for the ER docs or the hospital docs or whoever cleans the floor in the third basement. Some people in the department just shred them, and throw them in the trash. I try to make a point to fax the misfaxed fax back to whatever fax number is on it with the note "WRONG ADDRESS" scrawled across it, using the logic that if it was me involved, I would want to know that it got faxed to the right place, at least?

Crazy RxMan said...

I have about a dozen patients that each, individually, really and truly act like we're only at the pharmacy for him or her.

Obviously this insurance company believes you only treat this one patient.

Problem solved.

Anonymous said...

I think they're actually misinterpreting HIPPA and weren't right. My understanding is that HIPPA allows communications necessary to provide patient care. Communications between health plans and healthcare providers are specifically allowed-- they're both listed as "covered entities."

Anonymous said...

Could you figure out the patient via the insurance company? Just thinking that cross referencing the patient with the medication and the insurance provider would make it easier to isolate the patient before the big boom.
Or, you could always put up a "WANTED" bulletin board in your waiting room. Make the wait to see the doctor more entertaining.
Sorry for being bossy -- I hated getting yelled at by patients when I worked retail. I now work mail order and watch other people get yelled at.

Anonymous said...

I love that song! Anesthesia hymn is awesome too.

Packer said...

Make your accountant earn his fee, ask him to check which patients accounts were paid by that insurance company, and voila you will narrow it down to a few and you will shortly have your answer. 1099 from insurance company will just have been received.
Follow the money, always follow the money.

Library-Gryffon said...

I like jimbo26's suggestion. The only thing he's missing is the "No patient or PHI is included" message at the top.

rjs said...

How about you take the insurance company letter,
photocopy it,
write on the copy "the med for the patient your refer to is authorized for another year,"
and then see if they call you back.

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