Peer-to-Peer Physician Reviewer Bullsh%t

I am almost embarrassed to write this blog entry because it is so obvious.  Here is what just recently happened:

California’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.

During the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.

All of us doctors knew this already.  It is obvious these reviewers are scam artists when you talk to them.  They are lowlife sellouts who just deny your requests.  They ALSO have been taught to pretend to be victims if you get mad at them. That is their new strategy.  They start reading set responses like:

  1. “Dr ___, your tone is abusive and this call is being recorded.”
  2. “Dr ___, your anger is inappropriate and will be reported.”

All these are scare tactics.  I don’t know the answer.  Maybe this case will blow up but I recommend you try this when talking to a physician reviewer (this info was told to me and it works):

“Hi, before we start can I get your name and exact spelling, please?  Thank you.  I am putting it in the chart so if this procedure/test/referral is denied then your name will also be there for the attornies to question.”

So here are my questions:

  1. What are your most ridiculous rejections?
  2. What line do you use to get things approved?
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