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Absurdity is everywhere you look. Or don’t look.
As the old comedian Henny Youngman might have said:
Take my prior authorizations. Please!
Prior authorizations
1. Marissa had been taking isotretinoin for 2 months. She learned that three 20-mg capsules would cost her less than the two 30-mg capsules she’d been on.
My secretary called them. The insurance representative (Pharmacist? Clerk? Gal who stopped by to read the gas meter?) couldn’t help. “When I input your information, it issues a denial.” (Who is “it”? Watson’s evil twin Jensen?)
I got on the phone.
“Forgive me,” I said, gently, “but Marissa has been taking isotretinoin for 2 months, 60-mg per day. She was taking two 30’s. I want her to have three 20’s. They both add up to 60 mg. It’s the same dose. Why do you need to authorize it again?”
“Let me input that,” she replied. “Oh, now it’s accepting it. Your patient can have up to four pills a day.”
I was going to say she only needs three, but kept my mouth shut. Maybe Jensen only authorizes even numbers. 2. Danny has the worst atopic dermatitis I’ve ever seen. It’s all over him and never lets up. Topical steroids don’t touch it. Even prednisone – he’s had plenty over the years – barely makes a dent. I put in a Prior Authorization request for dupilumab.
“Your request for dupilumab has been denied,” read the insurer’s reply. “You have not shown failure with tacrolimus ointment or crisaborole.”
Say what? Prednisone didn’t help, and they expect tacrolimus or crisaborole to do the job?
I prescribed tacrolimus (which doesn’t come in a big enough tube to cover Daniel’s affected area anyway). It failed. Amazing.
“Your request for dupilumab has been denied,” said the insurer. “You have not also shown failure with crisaborole.”
Really? OK, I prescribed crisaborole. They denied coverage for it.
Now I was really getting into this. I wrote them. “I prescribed crisaborole.” I observed, “because you asked me to.”
They approved crisaborole. It failed. I reapplied for dupilumab. No response.
I called the insurer’s medical director, on a mobile with a Missouri exchange. After some telephone tag, he called back. “I cannot discuss this case with you,” he said, “because I have already made my determination.” Then he hung up without telling me what his determination was.
Further phone calls went unanswered. I thought Missouri was the Show-Me state.
The patient remained miserable. I decided to try one last time and wrote a long, sarcastic letter, detailing the whole episode. My secretary sent it off.
They approved dupilumab within the hour.
Malice? Nah, that’s giving them too much credit.
Now all Daniel has to do is improve.
Patient privacy!
Some news from abroad: what we know as HIPAA is called the “Data Protection Act” in the United Kingdom.
“We are obliged to conform to the demands of the Data Protection Act, and this specifically applies to the rabbi publicly mentioning the names of individuals who are unwell. The rabbi can only mention specific individuals with their permission or that of a relative designated by the sick person to do so. Anyone wishing for the rabbi to say a public prayer on their behalf must contact him directly by phone, text, or e-mail. To do anything else is breaking the law.”
If someone breaks this law, perhaps the rabbi can assist with atonement.
In any event, henceforth all entreaties to the Almighty must be encrypted. At least in the U.K.
What???!!!
Marina showed me her sunscreen. The label read, “Protects against UVA and UVB rays.”
“What’s the problem?” I asked.
She showed me our American Academy of Dermatology-produced sunscreen handout, which recommends “a broad-spectrum sunscreen that protects against both UVA and UVB rays, both of which cause cancer.”
“Does this mean my sunscreen causes cancer?” asked Marina.
“Not to worry,” I assured her.
I sighed and wafted a small prayer heavenward. Encrypted, of course.
Lo, the answer from above may tarry, but He will never forget His password.
Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at dermnews@mdedge.com.
Absurdity is everywhere you look. Or don’t look.
As the old comedian Henny Youngman might have said:
Take my prior authorizations. Please!
Prior authorizations
1. Marissa had been taking isotretinoin for 2 months. She learned that three 20-mg capsules would cost her less than the two 30-mg capsules she’d been on.
My secretary called them. The insurance representative (Pharmacist? Clerk? Gal who stopped by to read the gas meter?) couldn’t help. “When I input your information, it issues a denial.” (Who is “it”? Watson’s evil twin Jensen?)
I got on the phone.
“Forgive me,” I said, gently, “but Marissa has been taking isotretinoin for 2 months, 60-mg per day. She was taking two 30’s. I want her to have three 20’s. They both add up to 60 mg. It’s the same dose. Why do you need to authorize it again?”
“Let me input that,” she replied. “Oh, now it’s accepting it. Your patient can have up to four pills a day.”
I was going to say she only needs three, but kept my mouth shut. Maybe Jensen only authorizes even numbers. 2. Danny has the worst atopic dermatitis I’ve ever seen. It’s all over him and never lets up. Topical steroids don’t touch it. Even prednisone – he’s had plenty over the years – barely makes a dent. I put in a Prior Authorization request for dupilumab.
“Your request for dupilumab has been denied,” read the insurer’s reply. “You have not shown failure with tacrolimus ointment or crisaborole.”
Say what? Prednisone didn’t help, and they expect tacrolimus or crisaborole to do the job?
I prescribed tacrolimus (which doesn’t come in a big enough tube to cover Daniel’s affected area anyway). It failed. Amazing.
“Your request for dupilumab has been denied,” said the insurer. “You have not also shown failure with crisaborole.”
Really? OK, I prescribed crisaborole. They denied coverage for it.
Now I was really getting into this. I wrote them. “I prescribed crisaborole.” I observed, “because you asked me to.”
They approved crisaborole. It failed. I reapplied for dupilumab. No response.
I called the insurer’s medical director, on a mobile with a Missouri exchange. After some telephone tag, he called back. “I cannot discuss this case with you,” he said, “because I have already made my determination.” Then he hung up without telling me what his determination was.
Further phone calls went unanswered. I thought Missouri was the Show-Me state.
The patient remained miserable. I decided to try one last time and wrote a long, sarcastic letter, detailing the whole episode. My secretary sent it off.
They approved dupilumab within the hour.
Malice? Nah, that’s giving them too much credit.
Now all Daniel has to do is improve.
Patient privacy!
Some news from abroad: what we know as HIPAA is called the “Data Protection Act” in the United Kingdom.
“We are obliged to conform to the demands of the Data Protection Act, and this specifically applies to the rabbi publicly mentioning the names of individuals who are unwell. The rabbi can only mention specific individuals with their permission or that of a relative designated by the sick person to do so. Anyone wishing for the rabbi to say a public prayer on their behalf must contact him directly by phone, text, or e-mail. To do anything else is breaking the law.”
If someone breaks this law, perhaps the rabbi can assist with atonement.
In any event, henceforth all entreaties to the Almighty must be encrypted. At least in the U.K.
What???!!!
Marina showed me her sunscreen. The label read, “Protects against UVA and UVB rays.”
“What’s the problem?” I asked.
She showed me our American Academy of Dermatology-produced sunscreen handout, which recommends “a broad-spectrum sunscreen that protects against both UVA and UVB rays, both of which cause cancer.”
“Does this mean my sunscreen causes cancer?” asked Marina.
“Not to worry,” I assured her.
I sighed and wafted a small prayer heavenward. Encrypted, of course.
Lo, the answer from above may tarry, but He will never forget His password.
Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at dermnews@mdedge.com.
Absurdity is everywhere you look. Or don’t look.
As the old comedian Henny Youngman might have said:
Take my prior authorizations. Please!
Prior authorizations
1. Marissa had been taking isotretinoin for 2 months. She learned that three 20-mg capsules would cost her less than the two 30-mg capsules she’d been on.
My secretary called them. The insurance representative (Pharmacist? Clerk? Gal who stopped by to read the gas meter?) couldn’t help. “When I input your information, it issues a denial.” (Who is “it”? Watson’s evil twin Jensen?)
I got on the phone.
“Forgive me,” I said, gently, “but Marissa has been taking isotretinoin for 2 months, 60-mg per day. She was taking two 30’s. I want her to have three 20’s. They both add up to 60 mg. It’s the same dose. Why do you need to authorize it again?”
“Let me input that,” she replied. “Oh, now it’s accepting it. Your patient can have up to four pills a day.”
I was going to say she only needs three, but kept my mouth shut. Maybe Jensen only authorizes even numbers. 2. Danny has the worst atopic dermatitis I’ve ever seen. It’s all over him and never lets up. Topical steroids don’t touch it. Even prednisone – he’s had plenty over the years – barely makes a dent. I put in a Prior Authorization request for dupilumab.
“Your request for dupilumab has been denied,” read the insurer’s reply. “You have not shown failure with tacrolimus ointment or crisaborole.”
Say what? Prednisone didn’t help, and they expect tacrolimus or crisaborole to do the job?
I prescribed tacrolimus (which doesn’t come in a big enough tube to cover Daniel’s affected area anyway). It failed. Amazing.
“Your request for dupilumab has been denied,” said the insurer. “You have not also shown failure with crisaborole.”
Really? OK, I prescribed crisaborole. They denied coverage for it.
Now I was really getting into this. I wrote them. “I prescribed crisaborole.” I observed, “because you asked me to.”
They approved crisaborole. It failed. I reapplied for dupilumab. No response.
I called the insurer’s medical director, on a mobile with a Missouri exchange. After some telephone tag, he called back. “I cannot discuss this case with you,” he said, “because I have already made my determination.” Then he hung up without telling me what his determination was.
Further phone calls went unanswered. I thought Missouri was the Show-Me state.
The patient remained miserable. I decided to try one last time and wrote a long, sarcastic letter, detailing the whole episode. My secretary sent it off.
They approved dupilumab within the hour.
Malice? Nah, that’s giving them too much credit.
Now all Daniel has to do is improve.
Patient privacy!
Some news from abroad: what we know as HIPAA is called the “Data Protection Act” in the United Kingdom.
“We are obliged to conform to the demands of the Data Protection Act, and this specifically applies to the rabbi publicly mentioning the names of individuals who are unwell. The rabbi can only mention specific individuals with their permission or that of a relative designated by the sick person to do so. Anyone wishing for the rabbi to say a public prayer on their behalf must contact him directly by phone, text, or e-mail. To do anything else is breaking the law.”
If someone breaks this law, perhaps the rabbi can assist with atonement.
In any event, henceforth all entreaties to the Almighty must be encrypted. At least in the U.K.
What???!!!
Marina showed me her sunscreen. The label read, “Protects against UVA and UVB rays.”
“What’s the problem?” I asked.
She showed me our American Academy of Dermatology-produced sunscreen handout, which recommends “a broad-spectrum sunscreen that protects against both UVA and UVB rays, both of which cause cancer.”
“Does this mean my sunscreen causes cancer?” asked Marina.
“Not to worry,” I assured her.
I sighed and wafted a small prayer heavenward. Encrypted, of course.
Lo, the answer from above may tarry, but He will never forget His password.
Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at dermnews@mdedge.com.