tag:blogger.com,1999:blog-5883634615775822475.post3281285154728752724..comments2024-03-18T09:00:31.992-04:00Comments on Doctor Grumpy in the House: Sunday rerunsGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger47125tag:blogger.com,1999:blog-5883634615775822475.post-52517090797253363092012-06-13T05:17:25.428-04:002012-06-13T05:17:25.428-04:00Very late but...
Glad to be Italian.
T.Very late but...<br /><br />Glad to be Italian.<br /><br />T.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-29713446817452953982011-11-22T23:17:31.819-05:002011-11-22T23:17:31.819-05:00@peer reviewer
re: URAC (see urac.org) is the acc...@peer reviewer<br /><br />re: URAC (see urac.org) is the accreditation organization that all these insurers belong to. They require that peer reviewers be in the same specialty that they review....<br /><br />BULLSHIT. <br />I had a RADIOLOGIST DENY A SCAN ON ONE OF MY ONCOLOGY PATIENTS BECAUSE THE PATIENT RECENTLY HAD A SCAN (PAID FOR BY THE STUDY). YOU OBVIOUSLY DO NOT KNOW WHAT YOU ARE TALKING ABOUT. KEEP ON TAKING YOUR INSURANCE COMPANY PAYOFF MONEY....SCUMBAG.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-73385753549671480252011-11-02T10:26:46.020-04:002011-11-02T10:26:46.020-04:00Amen!
I would rather have a gov't entity who&#...Amen!<br />I would rather have a gov't entity who's not trying to make a profit on my illness make decisions on coverage than a corporation who keeps paying it's execs multimillion dollar bonus for screwing the patient.<br />Love your blog, Doc!AECDesignshttps://www.blogger.com/profile/07553779337491215587noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-61098909110073555112011-10-09T19:10:28.997-04:002011-10-09T19:10:28.997-04:00“BII will claim they never got our fax. Or that we...“BII will claim they never got our fax. Or that we filled the form out wrong.”<br /><br />I work in medical records and this drives me crazy. We get a fax saying approval is pending receipt of a list of documents. I look in the chart and see that you sent an identical notice three days ago and my co-worker listed a bunch of documents she faxed. Did you not receive the fax? Did you receive it and not review it yet? Do I re-send the same documents or assume you already have those and send something new? Why not say, "Thanks for sending ABC but we still need D"?! Seriously who is saving money in all this?photonhttps://www.blogger.com/profile/01315091820094203070noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-42204639531763971072011-10-06T12:05:09.110-04:002011-10-06T12:05:09.110-04:00I love Annie! Wish I'd had her on hand to tur...I love Annie! Wish I'd had her on hand to turn loose on the morons at BCBS in Oklahoma years ago. Two docs said I needed surgery, BCBS said no, I didn't meet the criteria. Well, what's the criteria? I don't know, the review panel decides that. Well, let me talk to them. No, you can't talk to them, they don't deal directly with patients! And around and around we went until I was a day away from showing up in their corporate office, unannounced and royally pissed off. <br /><br />tl;dr My doc finally got the surgery approved. Hmm, maybe Annie used to work for him.....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-75854151415227306422011-10-04T03:12:21.264-04:002011-10-04T03:12:21.264-04:00Whatever you're paying Annie, it can't pos...Whatever you're paying Annie, it can't possibly be fair compensation for how awesome she is.ER Mursenoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-39780758236097427152011-10-03T22:26:27.096-04:002011-10-03T22:26:27.096-04:00Still a can of worms...this go around. A peer revi...Still a can of worms...this go around. A peer reviewer in the field based his decision on words in my son's medical progress notes, out of context, and not anywhere near understanding their impact as to what was available out-patient. I wrote a letter explaining that my son's insurance decision-maker in discharging him early was the reason why he was re-admitted within a year of hospitalization, and sent the letter to the insurance company, the peer-reviewer's boss, and the hospital. The response from the hospital was to demand that the insurance company review the case and make a more beneficial decision to the patient (which would affect the insurance company). And, the hospital quoted statements from my son's medical record that gave conflicting and acrimonious rationale for coming to the peer-reviewer decision. I am not saying that reviewers are unscrupulous, nor am I defending anyone other than my son, but the physician that cared for my son every day while he was in the hospital had way more validity than what someone reading his records out of context. In a business office in an entirely different part of the country someone might have an entirely different mien, or point of view than the actual practitioner--medically-trained corporate minion versus medically trained physician. When I was training for the hospital pharmacokinetics service, my mentor could not stress enough his underlying theme--for God's sake, look at the patient, we're not in the business of turning out widgets.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-43445144615192426502011-10-03T21:45:17.639-04:002011-10-03T21:45:17.639-04:00Dr. Grumpy, this is making me tired.
*sigh*
My...Dr. Grumpy, this is making me tired. <br /><br />*sigh*<br /><br />My husband's 90 year old grandma got a same day surgery and state of the art rehab in Italy when she broke her hip a month ago. All covered by taxes that they've paid already, no fuss no mess. And Italy has one of the shittier systems over in Europe. I was duly impressed.<br /><br />Have you given Annie a raise yet?OMDGhttps://www.blogger.com/profile/17937425894428802591noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-84460341150911183762011-10-03T20:17:52.901-04:002011-10-03T20:17:52.901-04:00I'm an MD peer reviewer.
It is not legal for ...I'm an MD peer reviewer.<br /><br />It is not legal for insurance companies to pay their peer reviewers for denying care. I've worked for multiple insurance companies, including some of the big ones you mention, and I've never been offered/paid for denying care.<br /><br />URAC (see urac.org) is the accreditation organization that all these insurers belong to. They require that peer reviewers be in the same specialty that they review. This was true well before 2years ago when you first wrote this post, so I don't understand how you can possibly be reviewed by a retired dermatologist or OB GYN who hates his job. I've never been asked to review anything other than a case in my own specialty.<br /><br />Most of what I do is actually quality of care. It's not just identifying waste, but preventing patients from getting really, really crappy care. (Gee, doctor, pt still having his/her acute sx. Why haven't you adjusted their meds in the last week that they've been in ACUTE inpatient care? Oh, I see. You didn't realize b/c you've had so many admits? Or, my favorite "I'm just covering. The regular doc will be back next week and I don't want to change anything.") <br /><br />Many of my fellow docs operate under the Lake Wobegon effect. They all think they're above average. Unfortunately, many of them suck. I see it as my job to educate them/flag them for the health plan/get someone at the facility to do what's appropriate.<br /><br />Another example of waste: I've reviewed too many hospital cases where the only reason for continued stay was that the pt's roommate/husband/case worker couldn't come pick the person up "until Friday." Right. The insurance should pay $1000/day for someone's else's convenience.<br /><br />An easy example of crappy care from a review I did today: The attending spoke to the pt's wife on the phone (who he lives with) and it was apparent she had dementia. (In the same conversation, every 30 secs, she wanted to know where her husband was, when he had already told her, again and again.) They had no family support. I asked the attending if he was going to call APS (Adult Protective Services) so someone could go, do an eval, and make sure she was OK at home alone. He said no. Why? "She's not my patient." I made sure the insurance company arranged that.<br /><br />There are many, many examples of care being denied that should be. I'm not saying that there are no unscrupulous reviewers (I've reviewed, for independent review organizations, many myself), but demonizing the whole lot of them is wrong.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-88334310822985416842011-10-03T19:10:01.467-04:002011-10-03T19:10:01.467-04:00Re: the problems in Great Britain - yes there are ...Re: the problems in Great Britain - yes there are some problems especially for disabled people or people with some severe chronic conditions. However, I broke my arm two weeks ago, was admitted to hospital for 2 nights, have been given tramadol from the hospital pharmacy, seen specialists, had 3 sets of xrays, got transport home from the hospital and have a brace fitted. The only money this has cost me is transport back to the hospital for outpatient appointments. A friend has diabetes and never has to pay for needles and insulin as all this is paid for in taxes. I'm not sure how long this will continue though as the last government as well as the current one are trying to get more and more private companies involved which looks like it will be costing more money in the long term.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-3096008896910846462011-10-03T18:16:21.679-04:002011-10-03T18:16:21.679-04:00I <3 Annie!
We went to self-pay after trying p...I <3 Annie! <br />We went to self-pay after trying private insurance. What a joke THAT was! I save SO much money now, and just bank the difference from what we were paying in premiums, in case someone needs surgery or expensive imaging. <br />I guess you could say we're self-insured. The up side is, I get to earn interest on my own damn money and I get to decide if a test or visit is really necessary. We can see any provider we like, and typically get charged less because the office doesn't have to bill/fight anyone. It's a win/win and I kinda wish everyone paid cash so the overall cost of health care would go down. <br />Of course, that would put a lot of people out of work, but maybe it'd be worth it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-14760033950215854312011-10-03T15:44:26.335-04:002011-10-03T15:44:26.335-04:00Anonymous Mike:
I have BCBS, though not in Nebras...Anonymous Mike:<br /><br />I have BCBS, though not in Nebraska. What a POS insurance company BCBS is. I've been in more than one fight with BCBS and you know what? They always win, because I have an individual policy and no clout whatsoever.<br /><br />Though I'm American, I've also lived in Canada on a temporary work permit. On one occasion, I was forced to seek medical attention for a worrisome problem and was very impressed with the care I received. The docs took my symptoms very seriously (probably because I'm almost never ill) AND followed up with me a few days later. Wow.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-22257607657805045342011-10-03T13:23:12.121-04:002011-10-03T13:23:12.121-04:00Just because the federal government has meddled ex...Just because the federal government has meddled excessively with the medical profession doesn't excuse the practice. In my world, the costs have gone up tremendously every year for decades and the projected future costs are double digit multiples of the GDP. <br /><br />I might have different opinion when there is a guarantee a drug addict won't use my tax dollars to take an ambulance for a PAP smear.Jesshttps://www.blogger.com/profile/15969361446367636746noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-78457185203682396772011-10-03T13:18:45.143-04:002011-10-03T13:18:45.143-04:00Anon 8:49 - Here is the thing, I don't believe...Anon 8:49 - Here is the thing, I don't believe that government run health care will result in better and equal coverage for equal or fewer tax dollars. Look at Great Britain as an example; the government is running out of money and people are not getting the care they were promised. Now, my argument against socialized medicine does not mean that I whole heartedly support our current system. That is a false dichotomy on your part. I am not satisfied with our current system, but I refuse to substitute one system for another that is unsustainable and apt to fail.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-37042287222680246652011-10-03T11:29:10.308-04:002011-10-03T11:29:10.308-04:00People have simply GOT to understand this stuff, a...People have simply GOT to understand this stuff, and they don't. I wish there was a way to publish this blog post in every Letter to the Editor page in the country. Dr. G., you should send in a submission to Newsweek magazine for the "My Turn" section. I really think people would be in for a real eye-opener if they could hear what really goes on from an actual medical practitioner.Frantic Pharmacisthttps://www.blogger.com/profile/15804872250102867314noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-10265669520813773922011-10-03T09:53:39.334-04:002011-10-03T09:53:39.334-04:00Here's the difference. Annie got to vent some...Here's the difference. Annie got to vent some of her frustration at a hapless phone rep. <br /><br />If the government takes it over, Annie would've have ended up on a watchlist, audited by the IRS, or hit by a no-knock warrantless midnight raid. Fed employees get a whole different level of tools to fight back with against uppity serfs.ruralcounselhttps://www.blogger.com/profile/09193188081686431709noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-68360223144308205962011-10-03T09:49:02.878-04:002011-10-03T09:49:02.878-04:00My favorite part of the whole American Health Care...My favorite part of the whole American Health Care debate is that people will strongly oppose paying X dollars a year in taxes to pay for equal, if not better coverage, than what they likely pay double for through private insurance.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-17496520793223887452011-10-03T08:14:50.747-04:002011-10-03T08:14:50.747-04:00My husband has had debilitating knee pain and issu...My husband has had debilitating knee pain and issues for 15 years. His pain management doctor wanted to do a PET scan because the MRI and CAT scan weren't showing anything that would casue his level of pain. Blue Cross denied any other course of treatment instead. However they did approve surgery number 10. How does that make sense?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-35091297550255413502011-10-03T07:50:07.469-04:002011-10-03T07:50:07.469-04:00Anon 10:06: You are correct, and I've changed ...Anon 10:06: You are correct, and I've changed it.Grumpy, M.D.https://www.blogger.com/profile/09858110332436246760noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-9057074682892827972011-10-03T04:14:07.922-04:002011-10-03T04:14:07.922-04:00In today's world its nearly impossible to have...In today's world its nearly impossible to have any large procedure without going bankrupt. Some form of health insurance is a must if you have a health condition or are prone to getting sick. <br /><br />I'm glad that medicare is easy for doctors to work with, but as someone else said, it's also has a high abuse rate. These fraudulent claims cost taxpayers millions of dollars. Eventually U.S. taxpayers won't have the money, and a lot of people relying on the government wont have adequate healthcare coverage. <br /><br />That being said, I think you can guess I vehemently oppose the current health care bill. Other countries have turned to similar healthcare plans, but I don't think it will benefit the U.S. at this time. I don't want to get into a political debate, but right now there are just too many problems. Just to list a few.. Not enough people are paying their taxes. Too many people are relying on the government for medicaid and welfare benefits. Not to mention illegal immigrants using emergency services without paying into the system. <br /><br />I know some health insurance companies are hard to work with and are very bureaucratic, but not all companies are like that. <br /><br />I personally have been using Blue Cross and Blue Shield of Nebraska for 10 years. In those 10 years, I've had some major health problems, requiring me to see over 7 specialists, needing 2 MRI's (C-Spine & Thoracic) , multiple X-Rays, countless blood tests, an unexpected ER visit, several procedures and operations, and over 1 year of physical therapy. <br /><br />I'm not a doctor, nor do I work in the healthcare field, so I don't know how much of a pain they are to work with, but I can tell you that.. Out of everything I've been through, I have never had BCBS deny or reject a treatment. Even if it was very costly. They have never asked for alternative treatment before paying for something more expensive. They have never contested doctors recommendations (at least to my knowledge). And they have never challenged the need for expensive (non-generic) medications. I've also had them accept charges for early refills, even when it was due to my stupidity (dropping pills in water, etc).<br /><br />Wait time to see a specialist is based on the availability of a specialist - not when my healthcare provider decides its absolutely necessary. Mind you, it still takes quite a bit of time - with the average wait 2 months for the initial visit (generally can get an appt. within the week afterwards). <br /><br />I won't say BCBS is perfect, but It's a lot better than other healthcare providers that my friends use. To be honest, my only complaint with BCBS is from their billing department. I've had several problems with incorrect billing statements. I will pay the bill, then they will say the full amount had not been paid... so I send additional money. Then later in the month I will get a letter saying I overpaid, and they write me a check back. It always works out, but it can be frustrating to say the least. <br /><br />Sorry for the long winded post, that I'm sure is riddled with gramatical errors, but I really wanted to share my good experience with other healthcare providers. <br /><br />-Mike <br /><br />BTW: Way to go Annie! I was cheering at my computer screen as I read!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-10620387106333587842011-10-03T00:26:42.108-04:002011-10-03T00:26:42.108-04:00Annie for President! Or at least health care czar ...Annie for President! Or at least health care czar ...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-32100614967057310932011-10-02T23:43:50.571-04:002011-10-02T23:43:50.571-04:00Annie is just awesome.Annie is just awesome.X-Ray chickhttps://www.blogger.com/profile/05648533081425690258noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-72952949018106566742011-10-02T23:06:33.403-04:002011-10-02T23:06:33.403-04:00You couldn't pay me enough to do what Annie do...You couldn't pay me enough to do what Annie does - she is a goddess! However, please reconsider referring to her as your nurse. A nurse is a licensed professional regulated by a Board of Nursing. Medical Assistants are not licensed. Essential to excellent patient care, but not a nurse.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-87047506763149330262011-10-02T22:14:17.899-04:002011-10-02T22:14:17.899-04:00Annie is absolutely awesome! That is all.Annie is absolutely awesome! That is all.Morrishttp://morrisao.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-18355442435600235182011-10-02T21:41:43.264-04:002011-10-02T21:41:43.264-04:00@ a.generic doc: That is how socialized medicine ...@ a.generic doc: That is how socialized medicine works in Great Britain too. The government health care officials decide not to authorize surgeries or treatments on purpose so that people will either purchase private health insurance or the patient dies.Anonymousnoreply@blogger.com