Healthcare 101: How to Make It Work

After 27 years as a physician I think I have finally got the U.S. system of healthcare figured out: I saw a patient the other day just a week after surgery. Unfortunately, she was having pain after her surgery and the medication prescribed was not working to relieve her discomfort.  Problem was, the one was not working, and she was allergic to another entire class of pain medications.  So I did what I could and prescribed another, third type of pain medication. It is an old-timer, effective, and available as a generic. No problem, I thought. Good solution. Wrong.

An hour later we received the message from the pharmacy: my patient’s prescription would require pre-authorization from the large national chain prescription provider in charge of managing her Medicare medication plan. Okay. We were operating out of our remote satellite clinic and didn't have the same staffing as our primary office but, again, no problem. She needs it-- we’ll do it.

Thirty minutes later, while other patients had quietly waited, we had finally completed our odyssey through an almost never-ending phone-tree, spoken to a representative with all the sympathy of a cold piece of stone, and had finally obtained our pre-authorization. Well, not exactly. After all that what we received was an assurance that she would put a rush on our request for a pre-authorization. With any luck, my patient would have her answer in 24 hours. Thank goodness we asked for a rush appeal in light of the fact my patient is in pain.

This is a recent and endlessly frustrating episode. But it is not an isolated one. This routine is repeated every single day in our practice as we attempt to secure approval for prescriptions, diagnostic tests, or to schedule surgeries. I can’t help but believe that, for any dollars saved, an equivalent amount is wasted staffing these pre-authorization centers and our offices with personnel to chase down the approvals.

And so it is that, after 27 years, I finally realize how we can navigate this insurance controlled, money driven, convoluted system of  U.S. healthcare-- no hassles, no expense, no frustration:
                                          Don’t get sick or injured and you’ll be just fine.