I got a letter from an insurer the other day, warning me that my patient, who had just refilled a prescription for a bisphosphonate I had prescribed almost a year ago for severe osteoporosis (yes, I do still prescribe dugs, despite how I feel about Big Pharma marketing), also had a claims diagnosis in their system for a bleeding peptic ulcer, and was I really sure she should be taking this medication, which could worsen her ulcer?
So do what any conscientious physician would do – I call her. (Of course, no one is ever home when I call these days, so it’s another few days of phone tag before I get her.) No, she has not been diagnosed with anything of the kind. Feels great, in fact.
I press the point – did she see her primary for an upset stomach? Have a recent endoscopy? Pain? GI Bleeding? Is she taking any new meds, maybe something for her stomach like an H2 blocker (I name them all).
Nope. Nothing’s new.
Okay, I tell her. Take you meds and I’ll see you in the spring for your check up.
Waste of my time….
The scary thing is that diagnosis will likely be with her for a very long time. Sometimes, when I order labs on patients with medicare, the "qualifying diagnosis" isn't what he patient has (although it was what we were all taught in medical school). One is left with not adequately evaluating a sign/symptom because the bureaucrats that created the system don't have medical degrees or fudging. That may be what happened here.
But can I say that had I been the recipient of such a follow-up, I would have been tickled. What good care!
My insurer lists cataracts as one of my diagnoses–which is news to me and to both of my eye doctors.
that's kind of horrifying. reminds me of the time some years ago when one of those credit report outfits confused my sister and me — we have similar names, similar SSN's, lived in the same house growing up…
Wait until the end of the month productivity report is due and you get to explain how you "added value" to the patient's experience.
Be sure to tie your claims to evidence; it's best if you have objective evidence measuring the patient's experience. Extra points for bogus statistics that have no units.
I can't believe this happens regularly. I visited my insurance website and they have this health summary thing and it lists diagnosis that I never had.
I think I would be a bit freaked out but yet very cared for if I got a personal call from a doctor. I've never received one before. Thanks for taking the extra step in patient care 🙂
all Said…..The insurance company only has what they are sent. Coding, incorrect typing, provider other than primary all lead to poor claims. Insurance companies can't change it once it comes in. Whose fault? doesn't matter, we should all make sure that it is documented correctly and changed inthe system when we find out.
Yeah, last month I got a nice letter saying my patient had high cholesterol and why wasn't she on a statin.
Um, because she was PREGNANT?
grumble…
Hopefully they also sent a notice to whoever may have mistakenly submitted the ulcer paperwork. Hopefully the insurer has the time/resources to be concerned that they've paid for something that wasn't right.
I work in a data collection outfit and cringe at errors like that turning up because I know that it could well signal some other problem and my life's work is spent attempting to make databases be right.
While you legitimately view it as a waste of your time, as a someone concerned, and paid, to ensure data quality it would be hard for me to be happy with that flapping around out there in cyberspace.
Yeah, last month I got a nice letter saying my patient had high cholesterol and why wasn’t she on a statin.Um, because she was PREGNANT?grumble…
Yeah, last month I got a nice letter saying my patient had high cholesterol and why wasn’t she on a statin.Um, because she was PREGNANT?grumble…
that’s kind of horrifying. reminds me of the time some years ago when one of those credit report outfits confused my sister and me — we have similar names, similar SSN’s, lived in the same house growing up…
I think I would be a bit freaked out but yet very cared for if I got a personal call from a doctor. I’ve never received one before. Thanks for taking the extra step in patient care 🙂