Tell Your Patient When You Go to Bat for Them
The best part of my job as a podiatrist is saving, maintaining, and often times improving patients' lifestyles. The second best part of my job is interacting and meeting new people each and every day from different walks of life. I, for one, find this fascinating. Today was no different, except that I was able to share with a patient what it is like to walk a mile in my shoes (pun intended) in navigating today's maze on her behalf.
This particular patient of mine presented for a follow-up appointment to review her MRI results for suspected posterior tibial tendinopathy/tendon tearing. It had been four weeks since she was last seen in the office and the MRI prior authorization was submitted by my wonderful, well-trained staff that same day. This patient had her MRI performed three days prior to today's appointment. She playfully, made an off-hand comment "Well Dr Hall, you took long enough getting this MRI that my ankle is starting to feel better since I have been in this boot!" We both laughed. She was my last patient of the day, so I indulged a bit and responded, "If you don't mind, I would love to share with you the process of getting this MRI approved - I understand the delay was not ideal, but I think you will see the shortcomings of our healthcare system. Do you have a few minutes?" She of course obliged.
Me: It starts with a prior authorization request with submitted electronic medical records to your insurance company (in this case, Blue Cross Blue Shield of Louisiana) that is intended to save time and expedite care. In my medical records submitted (two office visits), I included a dictated X-ray report, your complete medical and clinical history and examination findings, your diagnosis, your failed prior treatment plans including: immobilization, anti-inflammatories, physical therapy regimen, activity modification, and functional orthotics over the past four weeks of treatment.
Patient: That sounds pretty thorough!
Me: Well, the insurance company still denied the MRI; but did offer a peer-to-peer review if we wanted to discuss the case further.
Patient: Peer-to-peer review? What is that?
Me: I am glad you asked. A peer-to-peer review is when I have to block out time out of my work schedule and have a conversation with another doctor who may not agree that you need a MRI. Often times this doctor does not even possess the same medical background as me - in your case, it was with a previous Emergency Room Physician (Side note: I always ask during my peer-to-peer reviews the doctors profession on the other end).
Me: Yes, but that is not the worst part. The Peer-to-Peer physician states that I should have ordered a foot MRI instead of an ankle MRI and that is why the request was denied. After a five minute anatomy lesson on the particular origin, course and insertion of the posterior tibial tendon, and the associated pathology suspected - we came to an agreement that the ankle MRI was indeed the correct imaging necessary and the MRI was approved.
Patient: Laughs, this is insane! I cannot believe you had to go through all that trouble. I wish they had just listened to you in the first place. I thought I had great health insurance?
Me: You do. You should see what we go through for those with bad insurance! Some doctors refuse to do them and the insurance companies know that and make it difficult for everyone across the board. For me, I always go to bat for my patients - even if it takes four weeks!
Patients: You are amazing!
A simple conversation explaining the obstacles you and your Staff face regularly is helpful for your patients to understand. How many of you have had a similar conversation with your patient? Comment Below!