Whose patient is it?

The pile of paperwork waiting for me in the clinic was no taller than usual, but boy did it make me see red!

Case 1: The lab had faxed a memo informing me that Medicare would not cover the cost of TSH and free T4 with the diagnosis “osteoporosis” I had listed for my patient and requested I provide a better diagnosis. I faxed back the form with the statement that I felt it necessary to rule out this potential secondary cause of osteoporosis. “Not good enough,” they faxed back. My phone conversation with the lab that followed was almost polite as they let me know that it was OK to be less than honest.

Case 2: The prescription for depo-testosterone 200 mg intramuscular every two weeks that I wrote for my patient with newly diagnosed hypogonadism also bounced back. “Please explain why you did not first prescribe conventional therapy.”

It seems that it is now legal for employees at health care insurance companies to practice medicine without a license. I contacted the reimbursement experts at the American Association of Clinical Endocrinologists and not surprisingly learned that I was by no means the first to run into either of these issues. The appropriate committee of AACE is aware of this and is actively engaged in stopping these and a number of other similar examples of the insurance industry playing doctor.

I would like to keep these bi-weekly blogs focused on diagnostic and therapeutic issues and not delve into politics, but I could not let these two cases pass without comment. For now as clinicians we have to protest these occurrences one at a time and I know each of you face similar absurdity on a daily basis. Please share your most egregious episodes and your thoughts on how to regain control of the care of our patients. Here is an alternative to consider: If each of us sends our senators and congressmen a copy of every one of these we get, just one day’s worth nationwide would get their attention in a hurry.