The Chocolate Lady

Tuesday, May 4, 2010

Common Sense is Boring

Im a little annoyed right now, as I realize that the chaos in my life is directly, inversely proportional to the lack of common sense in others.

Ive long had a lack of tolerance of idiocracy (which is officially a word, according to me), inefficiency, and arrogance...but when combined, they equal the decision makers at our medical group, which really sets me off.

I spend hours upon hours talking round and round with bureaucrats over decisions, where people like to mince terminology and processes...HELLO, how about we just use COMMON SENSE!

Perhaps that would be too boring. First of all, it would cut out the drama in my life, significantly x 1000, and then perhaps, the busy bureaucrats wouldnt have anything to do if they couldnt push my papers all around stamping, "DENIED" all over them.

Confused? Let me explain, using a dash of common sense, for clarity;

Pooper, as a cancer survivor, is at risk for secondary cancers, including skin cancer.

Pooper sees his pediatric oncologist every 3 months, which includes complete blood work. Not only is she a pediatrician, she is also an oncologist, just for clarity sake.

Our insurance has approved these visits, you would think that means they trust the doctor.

When said SPECIALIST (pediatric oncologist) identifies suspicious growths, she requests that they be mapped and biopsied by a dermatologist (also a specialist)

That seems pretty, obvious, right? I mean, yeah....they are suspicious, he is at risk, lets have them biopsied and mapped, right?

No...of course not, that would be using some common sense, and it would reduce the red tape that is strangling me.

What would be much better is to DENY the request, and then when someone calls asking WHY? You get to say things like;

The pediatrician wants to see if it is necessary (first of all a pediatric oncologist - ie. more of an expert - already said it was necessary, and if the plain old pediatrician says its not necessary, who's opinion should I trust? AND WHY ARE WE CREATING EXTRA STEPS IN THIS GAME?)

The pediatric oncologist (not to be confused with the plain ole pediatrician) didnt make it clear that is is necessary. Hmmm, really? So, her expertise and evaluation and request WERE NOT CLEAR?

You can just appeal it Really, oh good, I was sort of looking how to spend all the free time that I have (when Im not taking my son to extra doctors visits and playing ring-around-on-the-phone with insurance folk) but that doesnt answer the question; WHY IS IT BEING DENIED IN THE FIRST PLACE?

Let's see a show of hands, who thinks it's pretty obvious that he needs to see a dermatologist?

9 comments:

L.T. said...

Maybe next, the genius' will just flat out deny any of the three month check-ups: No check ups=no recommendations=no denial stamp=save even more money...until he gets real sick, from lack of preventative services. Which, of course, brings you right back to the here and now. I'm thinking this may be an issue better tackled by the Ped/Onc Doc or their staff to raise ---- with the insurance. Arrgghh.

Jason, as himself said...

Maddening! Just another example of insurance company badness!

Grandma J said...

I don't understand the game plan, and they all seem to play the game.

Anonymous said...

Too terribly frustrating! Don't give up though, even though it means spending every second on the phone in maddening conversations. Andrew definitely needs to have all those suspicious items removed and checked. You're a hero, Kim

Karen B.

heartshapedhedges said...

Thanks...it only figures that you, my readers get it, since I have the sharpest readers...

all the non-common-sense folks probably are the same people that 'dont get blogging'

such is life....

good thing Im a Trojan...I will Fight On!

Sally Cornejo said...

Maddening! Just another example of insurance company badness!

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