Monday, April 13, 2009

Insurance Company Idiocy

Last week I saw a lady in her 40's, who'd had a small stroke. She had no good reasons to have had a stroke, so I ordered a bunch of routine tests, including an MRA. This is not experimental. We do these for stroke all the damn time.

So her insurance company of course refused it. They asked to see my notes (we faxed them), and the reason why I wanted it (we told them). They still refused to cover it, but told me I could appeal by calling one of their "physician reviewers". So I called him a minute ago.

He asked me why I wanted the MRA. I told him because the patient had a stroke.

His response: "Oh, why didn't you just tell us that in the first place? We'll cover that".


Anonymous said...

With many similar experiences to yours, this one stands out in my memory: A patient had a stroke, and I ordered a CT scan of the brain (in the pre-MRI era). After many hassles, I ended up speaking to the insurance company physician who told me that they would only cover a CT if I first obtained a skull x-ray.

Grumpy, M.D. said...

yeah, I get that crap too. Can't do a neck MRI unless they have an Xray first.

But your's is better.

Rx Intern said...

Don't you just love insurance? Everyone gets the run-around, and it's near impossible to get anything done within a timely manner. Insurance + pharmacy = a nightmare for us. X isn't covered, Y isn't covered, blah blah blah, same thing over and over again.

Grumpy, M.D. said...

It's only gotten worse in the last year, too. Now I'm even finding some generic drugs need a pre-auth.

Rx Intern said...

That's just ridiculous! Generics needing prior auth is news to me (I'm not doing retail yet). Since when did insurance not cover the most used generics? Stupid bungholes need to get their act straight or else our health care system is screwed beyond belief. Pharmacy and medicine need to start banding together and bring about some change to our system.

Grumpy, M.D. said...

FDA loophole. For the first 3-6 months a generic is available, only one generic company is allowed to make it (usually the first to file an FDA application on it). And they charge almost as much as the brand, splitting the market in 2.

After that window is when the drug becomes cheap, because then any number of companies can jump in.

Grumpy, M.D. said...

Just FYI gang, I had to delete some comments. Someone made a reasonable political comment last night about this situation, but it was rapidly followed by several comments with political name calling back and forth by others.

To keep this from spiraling further and becoming Crossfire, I decided to delete all of them. I don't want this to be a forum to rehash the 2008 or future elections, regardless of what your side is.

Uro*MA said...

Gee, pre auth and pre cert is soooo much fun, i had an insurance company deny a ct abd/pel for kidney stone suspision because the pt did not have hematuria, can they do that? thats insane!!

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