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Preauthorizations
- Thread starter PsyDr
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Beautiful. He should do a sequel where the psychiatrist mentions in a note that the patient looks ever so slightly better and immediately the insurance company decides they don't need to cover inpatient admission anymore.
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This guy's awesome. Been watching his stuff for a while, lol
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If only that was all it took.
Once had a state medicaid doc, responsible for the authorizations of medicaid patients, who had the nickname of "Dr No" once try to distract the authorization for more days conversation by accusing me of medicaid fraud. Called his bluff. "Okay, Dr. No, if that is your assessment, you are mandated to report me for fraud of government resources, now that is a separate issue which you can do later after this call. Let's focus on what we are discussing now; which is the acute hospitalization needs of Patient. [more heated banter about why medical necessity existed for continued coverage]"
"you get one more day" talk with you again tomorrow and be sure to send the notes.
I spoke with med dir then I'm not going to waste my time and resources on unit to do those medicaid bed authorization extensions. One, we'll keep the patient anyways regardless of payment. Two its a non-profit hospital that was already getting grants +/- based on amount of indigent care. Three its a non-profit hospital that got tax breaks because it was 501(c)3. Four, the hospital was one of the worst Big Box shops nationally that just hemorrhaged money on stupid things. I was going to get worked up anymore over pennies - that was uncompensated time on my part.
Once had a state medicaid doc, responsible for the authorizations of medicaid patients, who had the nickname of "Dr No" once try to distract the authorization for more days conversation by accusing me of medicaid fraud. Called his bluff. "Okay, Dr. No, if that is your assessment, you are mandated to report me for fraud of government resources, now that is a separate issue which you can do later after this call. Let's focus on what we are discussing now; which is the acute hospitalization needs of Patient. [more heated banter about why medical necessity existed for continued coverage]"
"you get one more day" talk with you again tomorrow and be sure to send the notes.
I spoke with med dir then I'm not going to waste my time and resources on unit to do those medicaid bed authorization extensions. One, we'll keep the patient anyways regardless of payment. Two its a non-profit hospital that was already getting grants +/- based on amount of indigent care. Three its a non-profit hospital that got tax breaks because it was 501(c)3. Four, the hospital was one of the worst Big Box shops nationally that just hemorrhaged money on stupid things. I was going to get worked up anymore over pennies - that was uncompensated time on my part.
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Word of advice. If you are working inpatient and you need to get an authorization for insurance to pay for stay try this trick.
When you talk to the insurance's doctor, get their name, and where they practice. Refuse to talk to them otherwise. (They will have to identify who they are). IF this doc pulls some bull$hit like say the patient who just tried to attack you 3 hours ago isn't violent (and yes this did actually happen to me), if the doc recommends no further hospitalization, tell whoever is paying so long as HIPAA appropriate (the patient, their family) what happened and to report that doc to their state medical board and the medical board within the state where you are practicing.
When you talk to the insurance's doctor, get their name, and where they practice. Refuse to talk to them otherwise. (They will have to identify who they are). IF this doc pulls some bull$hit like say the patient who just tried to attack you 3 hours ago isn't violent (and yes this did actually happen to me), if the doc recommends no further hospitalization, tell whoever is paying so long as HIPAA appropriate (the patient, their family) what happened and to report that doc to their state medical board and the medical board within the state where you are practicing.
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BTW-no inpatient doctor I know thought of the above. I came up with the idea, but after I left inpatient work, so I never put it in action. While I'm not a lawyer I can't see anything wrong with it.
1-The insurance doc HAS TO identify who they are. (You should even ask for an NPI number).
2-Several insurance docs unethically deny coverage.
3-The doc typically dodges the inappropriate practice bullet cause the patient is never told who this person is, but if the insurance doc is making a decision based on clinical input THEN THEY COULD BE FOUND PRACTICING if making a decision denying coverage. IF anything it will at least tick off their medical board and lead to possible ethical repercussions with their local board.
I've also considered the following 1-the insurance doc could be considered practicing outside their state (unless they are also licensed in the state where the patient is), 2-Get the patient involved in legal action against that doc cause now the patient knows who made the decision and not some faceless identity.
And if you want to further be troublesome to the insurance doctor, that doctor could claim they're not practicing hence have no clinical relationship. This IMHO is BS cause the criteria of what creates a doctor-pt relationship is extremely light. E.g. if a guy talks to me about anything medical and I say anything a lawyer could say a doctor-patient relationship was formed.
So during your conversation with the insurance doc, anything that doc says that could establish a doctor patient relationship, chart it. Stuff like, "I've reviewed the case, the patient doesn't need hospitalization and will be fine." Well right there this doc evaluated, diagnosed, okayed the treatment, and recommended a prognosis. Or if you tell the doc they're not doing their job, a response of "I am treating this case with the same level of seriousness as I would with my own patients!"
You can print the progress note where you talked to this doc, put in their NPI number, and tell your patient of this record.
1-The insurance doc HAS TO identify who they are. (You should even ask for an NPI number).
2-Several insurance docs unethically deny coverage.
3-The doc typically dodges the inappropriate practice bullet cause the patient is never told who this person is, but if the insurance doc is making a decision based on clinical input THEN THEY COULD BE FOUND PRACTICING if making a decision denying coverage. IF anything it will at least tick off their medical board and lead to possible ethical repercussions with their local board.
I've also considered the following 1-the insurance doc could be considered practicing outside their state (unless they are also licensed in the state where the patient is), 2-Get the patient involved in legal action against that doc cause now the patient knows who made the decision and not some faceless identity.
And if you want to further be troublesome to the insurance doctor, that doctor could claim they're not practicing hence have no clinical relationship. This IMHO is BS cause the criteria of what creates a doctor-pt relationship is extremely light. E.g. if a guy talks to me about anything medical and I say anything a lawyer could say a doctor-patient relationship was formed.
So during your conversation with the insurance doc, anything that doc says that could establish a doctor patient relationship, chart it. Stuff like, "I've reviewed the case, the patient doesn't need hospitalization and will be fine." Well right there this doc evaluated, diagnosed, okayed the treatment, and recommended a prognosis. Or if you tell the doc they're not doing their job, a response of "I am treating this case with the same level of seriousness as I would with my own patients!"
You can print the progress note where you talked to this doc, put in their NPI number, and tell your patient of this record.
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