Certificate of Medical Necessity
A new hero is born and his name is Vance Lassey, MD. Ok, I have known Vance for almost 20 years since he was a writer for the Placebo Journal. I just love that he sent this Certificate for Medical Necessity filled out as above. He continually gets the same request and decided to give them a piece of his mind.
Enjoy.
Yes! I had a little fun on a Cigna disability form for my patient who survived a massive aortic dissection but had many consequences including an above knee amputation (from blood loss ischemia) Under “what prevents your patient from being able to walk more than 100 feet?” I wrote in “Lack of leg”. Multiple similar questions were given similar answers. Absence of leg, leg no longer attached to body, etc, etc.
He was gonna need about a year before he would be strong enough cardiac wise to prosthetic train, which he eventually did and walked like a champ.
In fairness to the insurance company, maybe they thought your patient was a reptile, and could re-grow the limb after amputation.
Far-fetched? How many of these do you have to fill out before you start wondering if the insurance back office is filled with lizards sitting at their desks.
Well, lizards make the most sense. Kind of thought Cigna was mostly lizards anyway. When I practiced had to do one of these at least twice for a guy who had lost his leg in an MVA 20 years before that.
Hilarious – bravo to Dr. Lassey! A large percentage of the population sucks, and mass corporate or government “solutions” for health care amplify that fact.
Well I see that MD’s who have a 90% successful Prior Authorization rate may get a Gold Star status whereby they can order without the bureaucratic hassle. My thoughts are that this might discourage a physician from placing an order which would benefit the patient, but may have the risk of dropping one below the 90% mark if denied. I believe it would be far better to look at practices where 85-90% of orders are denied upon appeal. This could weed out bad actors, while protecting mainstream practitioners.
Decades ago I was contacted personally by the Medical Director for ordering about ten times more sleep studies than my cohort. No financial ties to any sleep lab or mfg. My response was ” What is wrong with those other practitioners?” I guess I was ahead of my time. Now a sleep question has replaced STD questions on a CDL physical.
This is tame compared to some of the responses I put into such forms. I save my strongest words for work notes for seriously ill patients where the particular boss seems to be trying to give both me and the patient a hard time. It takes a lot of effort to resist the temptation to pepper the narratives with bad words.