“Doc, his MRI was rejected. You have to do a peer to peer.”
I hate that.
My staff had already spent half an hour getting the forms filled out and records sent over to the insurance company for the prior authorization, not to mention the time it had taken between the patient and the imaging center getting the thing scheduled in the first place.
I dialed the number and endured the automated phone tree. Finally I got a representative who informed me the phone call may be recorded for “quality assurance purposes.” Sure. Whatever.
I had to spend ten minutes telling the rep all sorts of things that they already knew. Why? Just because.
Then I was transferred to another rep and repeated the process.
“Hold while I get the doctor for you…”
Ten minutes later…
“Has he done a trial of NSAIDS?”
“Does he have any documented neurological deficits?”
“Has he demonstrated treatment failure after a round of physical therapy?”
“Yes! He had physical therapy two years ago and it did not help his pain.”
“Yeahhhh…. See, he is going to have to have done physical therapy in the past six months.”
“Physical therapy. It has to have been in the past six months.”
“What the hell? He has had cervical radiculopathy requiring two daily medications in order to function and after two years of this constant pain you are going to deny him an MRI? That is just plain stupid.”
The man had not been able to afford the MRI two years ago after he had gotten finished paying for the physical therapy.
“I know. But it isn’t my rule.”
“Fine. I will relay this information to the patient.” I made sure to relay my displeasure through the tone of my voice.
At least this guy was cordial. The last one I had to talk to was a real prick. It would be helpful if the rules were the same across the board but they aren’t.