Phone loops and paperchases

I am a healthcare worker, and I absolutely hate health insurance.

I thought at first that this much talked-about health care reform was actually going to reform the insurance providers, not make the medical providers job more difficult.

I hoped that health-care reform would make things simpler for the consumers, too. Medicare would be easier to understand. Coverage would be better.

That's not how it works.

Within an average day, we medical  assistants prep charts, room patients, assist with minor office surgeries, clean and dress wounds, give shots and vaccinations; any number of tasks that are person to person, and will help the provider (doctor, physician's assistant, nurse practitioner) in evaluating the patient for wellness visits as well as sick visits.

We also send out on behalf of patients for various types of testing, specialist visits, surgical procedures, and even elective procedures.

The medical assistant is the one who fields patient questions, passes on refill requests,  calls patient's with results, and manages keeping supplies on hand including drug samples, vaccinations, wound care items, and gloves. This equals a full day of work. Honest. But it isn't complete yet: A huge chunk of the medical assistant's time is filled with paper chases.

This is what I hate.

A  patient who has been under care for years for a diagnosis that will not change (diabetes, lupus, chronic obstructive pulmonary disease) will suddenly be informed by their insurance that a medication that has been helping them manage their illness well is no longer on the formulary.

That sets off a bunch of activity that may include trying to call the insurance and getting stuck in the everlasting loop of doom which, no matter how many times you ask for a representative, they cannot allow you to speak to one now, and tells you here is another bunch of stuff you don't need to hear that might help.

There are forms you can download to fill out and fax to the insurance company or the pharmacy supply company to see if you can get approval for the drug that actually works best for the patient. There must be proof that these other cheaper and kind of similar drugs were tried and did not work for the patient. Sorta like the drug they use. Sorta like this.

People expect this to be an immediate process. Computers are fast, why can't things be resolved fast?

Meanwhile, someone needs a MRI done to clarify a medical issue. Some insurance companies require a prior authorization to be done, and radiology cannot and will not schedule the procedure until the PA is obtained. This is understandable.

The thing is, you practically need to be a physician or at least have an eiditic memory in order to complete the process. Certainly you need to  have the patient's history in front of you when completing these on-line questionnaires. Where is that patient's history? On you EMR, on the computer you are trying to complete the form on.

I am over simplifying these issues, and I am still learning. I will never stop learning.  I tell people that this job, being a medical assistant, is my way of fighting Alzheimer's because there is not end to learning something new. But perhaps with experience, the paperchase will become easier and less of a pain in the hiney.

And pigs may just learn how to fly yet.