DR. HOOK- Playing doctor: When insurance companies overstep
"I'm not a doctor, but I play one on TV." Have you ever seen that famous commercial? An actor from The Young and the Restless said it in a cold-syrup commercial in the '80s. I use a similar line, "I am a doctor, and I look like Bruce Lee on TV." I wish!
I guess we all have alter egos (or altar egos if you're involved in a church), and mine happens to be a Broadway legend. Often people say to me, "What are you doing being a doctor? You should be singing at Carnegie Hall."
My response is, "Hey, did an Asian man play the king of Siam in The King and I? I would never get any work!" I realize my limitations, but do health insurance companies?
I work about 10-12 hours a day. After I finish seeing patients, I write up my notes, review health maintenance reports (like mammograms, prostate exams, colonoscopies), interpret labs, and notify my patients of the results, answer questions, blah-blah-blah.
Lately, I've been getting six, seven, eight faxes a day from health insurance carriers asking me to include them in the care of my patients who are their clients.
"Dr. Hong, your patient has signed up with our 'quality program.' Please send us copies of all labs, your notes, radiology reports, and your underwear size, mortgage interest rate, and how often you poop, while you're at it. Also, please fill out the following 18 questions— noting the dates when you actually did the following screening tests."
Have they lost their marbles? Is Anna Nicole Smith on crack the new CEO for health insurance companies?
If I were to answer all these questionnaires and send copies of everything after rifling through all the papers, it would mean two to three extra hours of work a day for me as well as my staff.
I understand health insurance providers want quality assurance, but the medical field already has its own quality assurance. Adding seven extra cooks ruins the broth–. (Just look at Bravo's show Top Chef.) I also think health insurance has killed off the rest of South America's trees to print their little notices saying, "Your patient's PAP smear is overdue."
Grrrr. Maybe it's because my patient was having her menstrual period on her last visit so we rescheduled her PAP– or maybe it's because she has an appointment coming up with her own gynecologist!
Also, health insurance companies pretend they understand how to take care of patients. The fact is, clinicians who go to the dark side of the force don't see patients. (I can already see effigies of me burning in front of health insurance companies. I have already been scolded by some people for standing up to them.)
I think one reason they're doing this "Let's help the patient program" is that they're paying for less and charging more, so they dreamed this up to keep their clients happy. It's bad news when a patient's co-payment overpays the visit charge. Every month, I have to write dozens of checks to pay back patients who overpaid. In these cases, health insurance doesn't pay anything, so the executives all go to Tiffany's and Mercedes-Benz with their bonus money.
Health insurance used to pay doctors less money if they ordered too many tests or prescribed too many medicines. It appears this new "quality assurance" thing they're doing is going to do the same– and frankly, it's going to make doctors refuse to participate in health insurance programs. I wonder if health insurance is going to be outdated soon anyway since companies are making patients pay for almost everything, and their premiums cost more than all the wars in history put together.
Soon TV ads will have an actor say, "I'm not a doctor, but I act like one as a health insurance CEO."
Have a medical question? Dr. Hook wants to hear from you!