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Thursday, March 14, 2013

And so it goes...

Not sure who should get blamed more for this one, the doctor or the doctor?
Patient Advocate: I'm working with a patient to get her p/a approved.
CP: Fantastic. I know she has been inquiring about this for a few days now.
PA: I have spoken with the insurance and the doctor so far.
CP: And what do you require of me?
PA: They (there's that pronoun again) said you need to start the p/a process.
CP: Huh?
PA: They said you need to send a form that explains why the doctor prescribed this medication. Why he is not trying other medications that may work and if the patient has failed other medications so this one may be approved.
CP: How am I supposed to know that?
PA: They said you need to start it.
CP: Who is "they"?
PA: The doctor.
CP: Um...Wouldn't the doctor know why the doctor prescribed something for HIS patient? Wouldn't the doctor know if HIS patient has failed something in the past? I have no forms to fill out from insurances. I have nothing to send to the doctor. Usually I just supply them with a phone number.
PA: I gave the doctor the phone number but they said they needed the form from you to start everything.
CP: <Reprints reject> All I have to fax to the doctor is a rejection from the insurance. It simply states "Prior Authorization Required. Please have doctor contact us at 1-800..."
PA: They said there's a form.
CP: That's all I have ever received from an insurance and all I have ever sent to a doctor to start a p/a process. Ever. The doctors usually receive these, call the phone number listed, then, depending on the insurance, either complete the process over the phone or receive the forms via fax directly from the insurance. I am completely out of the loop once I send them the phone number.
PA: Which I gave them.
CP: To be clear. You gave them the number to call. The patient gave them the number to call. They had the number to call in their chart. However, unless I, CP, directly FAX them the same phone number to call, they cannot figure out how to start the p/a process?
PA: That's how they made it sound.
CP: You realize the inanity of this whole thing, right?
PA: I do. But I enjoyed talking to you.

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