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Denied, Delayed… Disgusting.

A doctor recalls the day one of his patients came in with a headache and suffered an unfortunate circumstance, likely because of an insurance denial.

May 23, 2023

I remember the day when one of my own patients, Mr. Johnson we’ll call him, came to me with a headache.

I examined him and found that he had high blood pressure and needed immediate medical attention. Nothing too crazy, just a med to get the pressure down.

I recommended that he start the medication, which I prescribed.

Thinking he’d go home and fill it, I carried on with my day.

But he didn’t get the medication.

Or rather, his medication was denied.

 

You see, he needed to have prior authorizations filled out by me, his doctor, before the medication could be dispensed. But I didn’t complete them because I had gone home, and didn’t know that this was necessary. I saw the paper sitting there when I arrived at the office the next day.

When my patient heard that the insurance weren’t covering the med, that night at the pharmacy, he left. Went home frustrated, despite the pharmacist’s willingness to help, because he just “didn’t have patience”. 

This is what the insurance companies do! They don’t cover a necessary medication and drive us all bonkers.

Later that night, my patient’s blood pressure shot through the roof. I’d like to think it wasn’t avoidable, but maybe if he hadn’t been aggravated by the denial, or the need to go from place to place, or have to wait to get approval for something he clearly needed, this would not have happened.

He went to the emergency room.

 

“This is what the insurance companies do! They don’t cover a necessary medication and drive us all bonkers.”

 

The other day, I saw a tweet shared here which went like this:

“Here’s the dirty secret of emergency medicine:

We don’t have to do prior auth. Like ever. We just order what the patient needs, and the patient gets it done in the ED.

But here’s why we care about prior auth anyways:

B/c not a shift goes by where a patient doesn’t land in the ER as a last resort when #priorauth denied or delayed them the outpatient care they needed.”

(Tweet can be found here.)

The tweet reminded me so much of this story and I was so grateful to the person who tweeted it out, and especially for what she said at the end.

 

Most of you are probably wondering what happened to my patient.

He was initially ok, admitted to the hospital for observation, given his numbers, but set to be released the next day.

Later that night, however, I received a call informing me that Mr. Johnson had suffered a stroke.

I was devastated to hear the news and felt guilty for not having started the medication earlier.

I couldn’t help but feel like had he received proper care in time, his stroke could have been prevented.

I felt responsible for his well-being and wished there was more that I could do, especially after having known him for so long.

 

I’m angry and sad, both at the same time.

Incidents like these remind me of the importance of advocating not only for better healthcare policies, but for more seamless pathways to treatments.

There can’t be others involved in the decision-making, where people’s health is involved.

If a doctor decides a patient needs a treatment, no one should be challenging that.

Doing so only hinders care, puts patients at risk, and causes doctors to want to quit because of avoidable mistakes.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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