“Doc, they denied my MRI. The paper says… let me read it to you… ‘Must use six weeks of conservative treatment with a physician, including rest, ice, and antiinflammatory medication before eligible for approval.'”
She was angry. I could hear the implied accusation through the phone: You screwed up!
“As you know, this is a problem because the MRI was already done. This is going to out me over a thousand dollars.”
I couldn’t blame her for being angry.
“Ok, first, I do not understand why the imaging place did the study without insurance approval. Unfortunately, I have no control over that. The main problem, though, is that the insurance company is denying your MRI as if it is for joint pain instead of a mass which makes absolutely no sense whatsoever.”
I hung up with her and dialed the insurance company, hands shaking with anger.
I spent two minutes wrangling through their automated system, got hung up on, tried again. I was transferred to a person who took the info and again told me why the study was denied.
“Look, a mass is not going to go away with rest, ice, and antiinflammatories for six weeks.”
“So you want to talk to someone about that?”
I got transferred to another person and gave the info all over again.
“Ok, let me transfer you for a peer to peer…”
On hold for a few minutes…
“Hello? This is Dr. So-and-so. What is the problem?”
I gave HIM the story all over again.
“Well, we did not have all of that information. It says here the MRI was done for hand pain.”
“That is not the diagnosis code that I used when I ordered it.”
“I see that.”
It should have been a quick call.
What followed was a twenty minute lecture about how the bone mass was worked up incorrectly by me and that I should involve ortho from the beginning in the future because an MRI was not indicated.
What? Since when do you not do an MRI for a bone mass? I looked it up while he was talking just to make sure. I am over ten years out from residency, after all. Guidelines change. Yep. There it was. For this particular bone lesion, next step after plain films? MRI. The jerk was trying to cover up their ineptitude by pointing the finger at me.
I kept my mouth shut as he prattled on even though the anger was reaching a boiling point. All I wanted, ultimately, was for the MRI to be approved so my patient did not have to take the hit financially for something that was not her fault.
“I will go ahead and approve the study, but…” Blah, blah, blah.
You don’t know crap, sir.
I hung up and let the patient know that it was approved.
I was well over thirty minutes behind schedule on patients now and spent the rest of the morning having to apologize to everyone.
That afternoon there was a message from her husband. I braced myself as I clicked on it, expecting the worst.
“Thank you for everything you do for us, Doc. Have a good Mother’s Day!”
Here’s the thing: I teared up. Getting a thank you doesn’t really happen much these days. It threw me off balance and the rawness of the whole unpleasant experience that I had been carrying with me all day bubbled up and then melted away.
It’s my job. I am happy to do it. But I had forgotten how much power a “thank you” can hold. So… I will remember. I will hold onto this and I will work harder to show my own gratitude to those in my own life.