OK, got to vent on another one. I guess I am just getting too old for this.
Had a patient with over two years of right rib, right thoracic spine pain which I had previously done some level one evaluation on, turned up all negative. Now, this patient is not a "frequent flyer", in fact had not been in for 2 years. We had sent/called her several times telling her she was due for office follow up and then finally got her in. She continued with these complaints, worse when walking, worse with movement blah, blah. Exam was totally negative except for minimal tenderness over the right infrascapular area and a little bit in the right CVA. I tell her I believe it is musculoskeletal and conservative treatment is indicated. I also tell her one could never rule out a thoracic disc or facet problem which might benefit from steroid injections but that, from experience, I know the Pain guys in my area will not do anything without first having an MRI. I also note she has 1+ blood in her urine which is asymptomatic. She had a few RBC's 2 years ago. So, my "worst case scenario" brain kicks in and I decide perhaps it would be wise to get a CT of the abdomen/kidneys. She says she wants to find out what is going on and that, with the direction health care is going she wants it "DONE NOW!!!"
So, I order an MRI of the T-spine and a CT abdomen, send the UA for C&S..blah, blah.
Her insurance company refuses to approve either test unless I call their doctor to discuss it. My staff has already been on the phone for over 30 minutes (much of it on hold) answering questions and they have faxed my notes to them but still no go. I am busier than heck seeing patients and tell them I cannot call their doctor.
The patient calls back irate that I will not make this "simple call which will only take 2 minutes" for her. I try to explain that this is just another tactic for her insurance to deny services to her and that I cannot spend what is invariably way more than 2 minutes talking on the phone to try to justify my clinical decisions to some hasbeen for every test I order. I tell her there is nothing else I can tell them that has not already been transmitted to them via my staff. So the insurance company does not actually deny the tests, they simply won't approve until I call them. Makes me the scapegoat.
She says she and her husband have always appreciated the care they have received from me, have always been grateful that they can usually call my office in the morning and be seen that day but that perhaps it is time for me to retire. She then proceeds to say things like this must be the reason my waiting room is never very full!!!! OK, now she has really lit the fuse! I reply (I know I should have just let it go, but, well, you know me) my waiting room is never crowded because I do not double and triple book, I spend quality time with my patients and I am not always running late BECAUSE I AM NOT ON THE DAMNED PHONE WITH INSURANCE COMPANIES LIKE HERS!!
Well, you know the rest. She said she and her husband would be finding a new doctor and I said I thought that was a good idea and that I hope she is happy sitting in a waiting room with 40 other people (Please forgive Medical Protective)
