behind the scenes, insurance insanity

Watch an Insurance Company Try to Drive Me Insane..Yet Again

Well, I guess I’m sort of creating a series about insurance company insanity.  I didn’t start out meaning to do it, but so many opportunities keep presenting themselves!  Here’s a new one.  One of my patients needed to get a specific type of stress test.  Of course, I can’t just order it.  No.  It has to be approved by her insurance company, via a middleman company that runs their approval process.  So, first we call them for approval.  Then we send a copy of my office notes.  Then, without fail, this happens.

This message  says that my office notes that I sent them don’t meet their clinical guidelines for approval.  I need to call them and talk to the physician reviewer to plead my case.  Note that the message was received at 4:45 PM.  Convenient.  I was not able to return the call that business day.  A good thing, too, since the next morning first thing off the fax, is this:

A notice saying they’ve approved the stress test, even though about 12 hours before they had denied it.  I never called them.  So, what happened between 4:45 PM on April 23 and 8 AM on April 24?   I have no idea.  Nor do I wish to look a gift horse in the mouth.  However, the best part of that approval fax is that right after we got it, we got this:

Yup.  You read it right.  Another request for additional clinical information, for the test they had already approved.

Just another day at the office.  Just another gray hair.

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