We Need to Detain You

In order to be a successful dictatorship, you must create a climate of fear.  This means periodically arresting or intimidating innocent people and accusing them of serious crimes.  Eventually, the accused is released with a warning.  The theory is citizens who are afraid of committing minor infractions will not even think of doing something more radical in the future.

Anthem BC/BS Health Insurance is using a version of this technique.  I received a letter yesterday.  The letter accused me of charging for impacted ear wax removals at a frequency well above my peers.  The letter told me I needed to call them immediately to discuss this with their “Physician Education” team.  I pictured a uniformed patrol would soon be dispatched to detain me in a “Re-education Camp,” designed to get my mind right through various punishments and hard labor.

Let’s talk a bit about ear wax: We audit our charges regularly and my use of the charge in question is in line with other providers.  I actually am not fond of the procedure which can often be time-consuming and difficult.  Typically, the issue comes at the end of a complex visit.  On exam, you find the person has ears that are really packed tight with ear wax, requiring a combination of irrigation, scooping and manual extraction.  Great care is necessary.  Yet, the relief expressed by patients at the end of the process is rewarding.  Quite simply, people find they are no longer deaf!

Often, the patients are sent in by Audiologists who are not permitted to remove the ear wax.  The alternative is to send people to an ENT doctor, which has a wait time of many weeks and a price tag that is quite high for the patient and the insurance company.   Rarely is such a referral medically necessary.

I spoke with our practice consultant and Anthem has been sending out a lot of these letters for similar bogus reasons.  Often the letters reference charges which were not even submitted by the doctors in question.    So, as demanded by the letter, I called the number and spent 40 minutes on hold. A nice lady eventually came on the line and told me not to panic.  They just wanted to make sure I was submitting the proper documentation to justify the procedure.   She didn’t know what specifically that was and nobody had even seen my documentation for the ear cleanings (which I am careful to document in each note).   It was kind of a good-hearted warning to keep me off balance in case I had even an inkling of trying something more devious in the future.

Thus, Anthem is maintaining fear among its subjects to maintain its tyrannical grip.

Steven Mussey MD

Steven Mussey, M.D. is a physician in Internal Medicine, practicing in the Fredericksburg area for more than twenty years. He grew up in Springfield, Virginia and earned a degree in Physics from The University of Virginia, Phi Beta Kappa. He earned his medical degree at The George Washington University and was inducted into the medical honor society AOA. He is Board Certified in Internal Medicine. He served in the Air Force for four years before entering into private practice. He particularly enjoys geriatric medical care and working with complex patients. For almost a quarter century, he has been practicing with one other Internist. Both doctors enjoy practice in a small, but busy office, and plan on working into their 70s, as long as they can still find their way to the office. Dr. Mussey is also an avid cartoonist and has a weekly cartoon in the local newspaper. He also enjoys cartoon animation and has had several public service cartoons playing regularly on the television cable systems.

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16 Responses

  1. Gary J. Pearce says:

    Should we just tell our patients that we cannot provide the service because their insurance does not cover it? It would obviously generate a lot of animosity if we were to collect directly from the patient. We cannot, and should not, be stuck dealing on hold with insurance companies that do not really care about “provider relations”. How about just forwarding a copy of said letter to the affected patients so they can book their appointments with the ENT specialist in advance. Let them do the complaining…to the insurance company or the insurance commissioner!

  2. Sarah Arnold, MD says:

    You were really nice about it. I would’ve demanded Anthem send me an apology for their accusations. We do a lot of these ear wax cleanings in urgent care, it is a tedious and time consuming procedure, and merits appropriate reimbursement.

  3. David Sokolow says:

    Now I understand why I had increasing difficulty hearing your recommendations after my last few visits with you, Dr. Mussey. The problem was exacerbated when I called Anthem, was put on hold for 40 hours, and could barely hear their response to my inquiry on this topic.

    Because I couldn’t hear your medical advice, my BMI is now 57, my HbA1C is 17.3 and my resting BP is 300/200.

    Anthem just notified me that they are raising my rates and I do not understand why.

    So maybe there is a method to their madness

  4. Bruce Bonanno says:

    Years ago I also learned that you had to include “use of come kind of instrument (cerumen spoon) ” in addition to irrigation in order to get reimbursed in the ED.
    document , document, and document!!!!

  5. ken Luckay says:

    This is why I no longer accept Anthem insurance. Got fed up with all the hassles. It has been rough for my patients, paying cash and then fighting with Anthem over payment, but they (mostly) understand. I suggest to them they consider changing to the insurances I do take.

  6. Stewart says:

    Continuing my rant:

    In no way can someone who gets their rocks off by abusing physicians in this way DURING A PANDEMIC be described as a “nice lady.”

    She is a profoundly evil, bottom-feeding parasite – and these people need to be told this every chance we get.

    When I have to get involved in a pre-auth (100% success rate of course – it’s just a stalling technique on their part), I have a nice little speech I deliver at the end of the call. It’s particularly rude and ugly if I’m forced to do a “peer-to-peer” with one of their whore physicians.

    Accomplishes nothing, but sure does make me feel good for the rest of the day.

    • Martha Clark, RN says:

      Exactly!

      “Prior auth” means “if we toss enough forms that require attached pdfs and trials of otc meds, maybe you’ll come to your senses and NOT prescribe the Alinia”.

      My recent prior auth experience.

    • Mamadoc says:

      I once had a ‘peer’ tell me he was a ‘doctor just like you.’ Acuatally, no. I worked for a living.

  7. Martha Clark, RN says:

    So typical! And our patients wonder why we just toss them a box of Cerumenex.

    To avoid the boot-to-the-head from their insurance company!

    Like they think we ENJOY this gross, but sometimes necessary, procedure!

    • Stewart says:

      I once made the mistake of doing an ear lavage at the same visit as an annual physical.

      BC/BS claimed that EVERYTHING – the H&P, the EKG, the lab work, the tetanus booster, the Pap smear – was incidental to the ear lavage.

      It took months and countless hours to get that corrected.

    • Rick says:

      Martha, very good point. I feel they do it to make Docs think twice before cleaning out another ear, and perhaps do half as many.
      The fear is real…

      • Martha Clark, RN says:

        Indeed! And meanwhile my 80 yr old father, who wears hearing aids, is struggling with that tiny Cerumenex bottle.

        It’s all about control!

  8. Stewart says:

    You’re too nice.

    You should have gotten her name, and told her that she would be hearing from your lawyers when you sue for libel.

    This is frank abuse of physicians, and those who claim to represent us, the medical societies, have absolutely no interest in doing anything about it.

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