We all go to work in the morning, looking forward to the day. I know I have about 26 patients and about 20 other tasks to do for the day. I know that my medical assistant has about the same ( or more ), and we are ready to go. “Good morning Sophia,” I say to my medical assistant as I walked into the office. She has already roomed the first patient, and she seems to be anxiously waiting for me before I walk into the room. “So, before you walk in, this patient is agitated. She says that we denied her prescriptions, but I tried informing her that the insurance wouldn’t cover even with prior authorization, but she says she already called them. I tried letting her know that they have strict criteria, and only then will they cover, and she didn’t meet a portion, so they denied it, I showed her the letter, but she says that we didn’t write something correctly in her chart?” I go in and calm down the angry patient who has already expressed her frustrations to her. While I apologize for the outcome, I see that even though we have written the criteria in her chart multiple times, her insurance wants a line to be in the note verbatim. Needless to say, we rediscuss the medication and write as the insurance prefers. After a few happier patients are checked out, I see that a couple of my patients are not checked in yet, and I check to make sure everything is ok. She’s on hold with an insurance company trying to get a prior authorization form faxed over. She says she’s called numerous times already, but the hold time was too long, and this time it says 10 minutes. I leave her to the tasks and get the patients taken care of myself. We receive the forms but not before she has called 3 other times trying to do the same thing. It turns out the request for a fax to be sent was submitted but never the fax itself. After finally filling everything out for a continuous glucose monitoring system, we receive a denial. Disappointed, we inform the patient and keep moving. Later, she approaches me and says, “I have a patient on the line who doesn’t want to talk to me. They only want to talk to you. I already informed them of the lab results, but it looks like something wasn’t covered with their insurance. I tried informing them that we need paperwork to fix it, but they say it’s our fault they’re not covering the labs, and now they want someone else. I don’t know why they keep blaming us.” I speak to the irate patient who complains about not getting their instant gratification met. I apologize for our mistake and write a letter of medical necessity to try and convince the insurance that it was necessary. I reassure my medical assistant that she did everything right. I look at all these situations and wonder why we are still doing what we do despite similar scenarios. A few years ago, I was a trainee, and there was no concept of a medical assistant. This one person is in the front for check-in and the back rooming patients. They answer phone calls, relay information for patients, and handle various administrative duties and clinical. Over the last several years, I have watched medical practices get more complicated, requiring more staff to maintain the same volume of patients and sometimes greater. The medical assistant’s role has come into the picture, and the demand has grown with increased duties than the role was created for, in my opinion. I am an endocrinologist. Our practice is especially challenging, given all the complicated patients we see and the never-ending list of branded medications we have to use. That’s the keyword, branded that starts the never-ending hoops we have to jump through even to get medication or even treatment so the patient can get better and we can help the world be a better, healthier place with each person. There are many problems and questions that arise with these scenarios every single day. Why is it so difficult to get good, affordable medical care to patients who need it? Why is it that it is the physician’s office’s responsibility to get the medication or treatment to the patient and not the patient themselves? Why do we have to document so much and try so hard to get the necessary treatment? Why do we have to tolerate inappropriate behavior from some patients? Why do people not behave with respect towards the person who is only trying to help? I don’t know if we have any answers, but we need to get them as soon as possible. We are on a slippery slope, and it is going down fast, and it just doesn’t seem right. There is already a declining interest in the medical field across the board, and if this keeps going, we may not have enough staff and providers in health care. Sameera Tallapureddy is an endocrinologist. Jackie Perez is a medical assistant. Source
