by Jeoffry B. Gordon, MD, MPH

I have always considered it to be my professional responsibility and ethical imperative to fight for my patients with the insurance companies to get approval for every test and medication that I think is medically necessary.

My batting average is close to 100% Lately, the insurance companies have been trying to draw the noose tighter and make the task of getting approval more and more onerous. By establishing these barriers and reviews the insurance companies are obviously adding to their profits (while at the same time promoting and accounting for these programs as quality improvement efforts) and never thinking to pay us extra for the additional work involved.

By my data, the major insurance companies have actually lowered their reimbursement levels for primary care office visits over the past 5 years and, of course, they pay us nothing for the effort of getting the approvals — or for the pleasure of trying to explain a medical problem or diagnosis to a clerk.

Thus, I have drafted up the following notice for my patients:

As you are all aware your health insurance policies have become more restrictive and more expensive and they are becoming more so in an accelerated fashion.  They have imposed increasingly large financial burdens and administrative barriers on you to restrict your access to the medications, evaluations, and treatments that you need to get better or stay well.

As you can imagine these administrative complexities impose a great responsibility on my office. As your doctor, I and my staff are committed to obtaining all necessary and appropriate approvals from your insurance company in an expedited fashion to obtain the care you need. My attitude is that I should be an advocate for you in these matters. My office is especially proud of our track record in confronting the insurance companies to get needed care.

Nonetheless, you should be aware that this responsibility imposes an increasingly great burden of time and effort on us which subtracts from our availability to care for other patients. A recent study in San Francisco showed that the average doctor spends about $70,000 a year dealing with insurance companies. In certain circumstances this insurance process can be especially complex and prolonged and in other circumstances you, as a patient, may want or desire prescriptions or referrals (for example for brand name medications or MRIs) which are especially difficult and time consuming to obtain.

Under these circumstances, at my discretion, I will be imposing a fee of $50 to be paid in advance for the time and effort necessary for me to cope with this bureaucratic morass.

This an important tool for bringing the malfunctioning and anti-patient aspects of this increasingly irrational system to patients’ attention. Just as obvious is the potential for alienating them. I wonder if it is against our provider agreements with the insurance companies to render this charge.

Has anyone come up with another way to cope with it?

Jeoffry B. Gordon is a family physician.

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