Heart Trouble and Insurance Woes
Let’s see now, where was I? Heart trouble, that was it.
Oh yeah, well most important, ole Snook did just fine, and he’s still edging me out of a cheeseburger every so often.
He was lucky. He gave a good history, I was there, and I knew how to maneuver his insurance company into doing right by him. The job description for a modern country doc has changed some. Your doc should still be Board Certified, have to desire to get to know you as a person and care about you like you were family.
Nowadays add another prerequisite, though. Part of the task is to know how to be a street fighter with the insurance companies. Dr Groopman spent a fair amount of time on algorithms and how they can be an impediment to care. With that in mind, I thought I’d tell you how Snook got taken care of in spite of the meddlesome insurance bureaucracy.
Monday after my round of golf with Snook, I ran into my buddy Boykins Douglas, our local cardiologist, on morning rounds.
“Dawgless, what’s happening?”
“Hey Bibey. Y’all gonna do the heart gig again this year?” We had played for the Heart Association for ten years running, although they would not allow a pig picking, our cuisine of choice.
“More than happy to brother, you just gotta do me a favor.”
“Sure thing. Whatcha need?”
“You know Snook, don’t ya?”
“Sure. If I had to depend on Snook to make a living, I’d have to find a new job. That cat never goes to the doctor. What’s up with Snook?”
“New onset angina, at least I’m pretty sure.”
I already had the Dawg’s attention. “Any chest pain?”
“Naw man, but he sure enough has exertional dyspnea. (shortness of breath) We walked nine yesterday, and I wasn’t sure he was gonna finish. Off twenty yards on his drives, too. It’s atypical, but I’d bet 70% odds on it. Don’t like it at all.”
Dawg had gotten used to my bluegrass slang and encrypted medical lingo over the years, but he knew I knew my people. “Will a treadmill do it, or you want to nuke him?” (Slang for nuclear treadmill.)
“I don’t know. I gotta get it by his insurance company. I’d vote for a treadmill with a bailout nuke if he can’t cut the gig. I’m concerned about his exercise tolerance- he looked pretty short of breath yesterday.”
“Where is he now?”
“Home. I tried to get him to come in yesterday, but no tickee. I had some aspirin in my glove box, and started him on that. He’s supposed to be on bed rest with bathroom and meal priveleges till I call him.”
“Didja get him to give up cigarettes?”
“I’m a doctor not a miracle worker, Dawg.”
“I understand. Get me a pre-auth. (pre-authorization from the insurance company.) I’ve got two caths this morning- I’ll come back from lunch early and do him at 1:00.”
“Thanks Dawg, I owe ya one.”
“Just get me a number. I don’t mind doing a nuke for him, but I’ll catch hell from administration without prior approval.”
“Will do.” I scurried to the office.
I gave our referral secretary the assignment first thing, ’cause I had a lot of folks waiting on me. I saw the first few patients, and went to check on her progress.
Annie had run aground. “Sorry boss, they won’t even discuss it- no office notes.”
“Well excuse me for no Dictaphone in my golf bag. I keep Epi in there in case of a bee sting, but I guess I wasn’t prepared.”
“They said they would consider it if you talked to the nurse directly.”
“O.K., get ’em on the line. I’m gonna see a few patients.” I shook my head. “Be prepared, gonna go back to “d*** Boy Scout school,” I muttered as I walked out the door.
“What did you say, boss?”
“Aw, nothing Annie. Just get her for me. Snook’s on deck for 1:00. I gotta get him covered. He doesn’t need to get stuck with the tab.”
Directly Annie tracked me down. “I’ve got ’em on hold, Dr. Bibey. They say she’ll be right there.”
I wrote the last script for the patient in exam room two. “O.K., Ms. Bee. You’re good to go for three months. I gotta grab this call. We’ve got a bit of an emergency going on. If you think of anything else, tell Myrd. I’ll be back in a minute- you can hop down.”
“Young man, I do not hop.”
“Yes, ma’am.” I glanced at Myrd, who took the cue, and held Ms. Bee by the arm to help her off the exam table.
I went into my study, and closed the door. Sometimes these discussions brought out a side of me I didn’t like, and I didn’t want my staff to see it.
I held and listened to the canned company music. Of course, bluegrass is my favorite, but jazz, big band, classical; anything but that dang elevator stuff would work. I was already in a bad mood.
“Yes, yes. Oh yeah, uh… thank you.” Dang it, I had dozed off.
“Please be aware this call may be monitored for quality assurance purposes.”
“Yeah, O.K. I got it.”
“How may we help you today?”
I wanted to say how ’bout you just give me a number for Snook’s nuke, but I knew that wasn’t gonna get the job done. I tried to be professional. “Yes Ma’am. My name is Dr. Tommy Bibey. I have a patient, Snookers M******. He needs a nuclear treadmill today, pronto. I need to get a pre-auth number.”
“Let’s see Dr. Bibey. I do not have any office notes. We generally do not process these without supporting documentation. If you will fax them to us, we will give it full consideration.”
What to do? Somehow I didn’t think this lady would take to the fact the diagnosis was made on the tailgate of a pickup truck. Hated to do it, but it was time to lie. “Well I’m sorry ma’am, but the transcriptionist is out today. The dictation won’t be in until tomorrow. I’ll be glad to fax it then.”
“And do you have an EKG?”
“Well, no ma’am. I saw him yesterday. I tried to get him to go in the hospital, but he wouldn’t do it. You know how it is ma’am. He’s a man- stubborn.” The line was quiet. No laugh. Uh, oh. I’m in trouble.
A tune started to gel in my brain. “I got them mean woman blues, I don’t know what to do…” Oh well, at least I wasn’t married to her. Focus Bibey, focus.
She droned on. “Yesterday was Sunday. Do you have office hours on Sunday?”
“No ma’am. It was a uhh…, a house call.” Dang it, another lie.
“No office notes. No EKG. Dr. Bibey, I have to answer to my superiors. I have responsibility for decisions. They must be evidenced based.”
Yeah, well it ain’t like no one’s checking behind me, I thought.
“Does he have any chest pain?” She went down her list.
“Well, no ma’am. Exertional dyspnea, though.” I didn’t tell his drives were off twenty yards. Somehow it didn’t seem the right play.
“Let’s see . Your secretary gave his age as 59 1/2. He does not meet the criteria to approve cardiac imaging studies for exertional dyspnea. Now, if he were female or six months older……”
Oh, GG (Good Grief) lady, I thought. I ain’t missed that question on the Boards in twenty years. Gimme a break. Somehow I held my peace. “Ma’am who is your doc today? Maybe I could talk it over with him.”
“Let’s see. That is Dr. Thompson. He will be in at 2:00 if you would like to call back.”
D*** it. Too late. Better reverse field. “Is that Dr. Paul Thompson, III?”
“Yes, so you know him?”
“Oh yes. He is a good guy.”
“He is? How do you know him?” She was surprised, and sounded quite skeptical. Great – just the response I hoped for. I’ll bet they had some run-ins over the years. I had an opening, and I was gonna drive this truck on through it.
“Oh yes, ma’am. Tell him Dr. Tom Bibey called. We worked together on a case last year. I couldn’t get a nuke on my man and he had an M.I. (heart attack.) The patient did well, but the family was incensed. They wanted to litigate against Dr. Thompson, but I helped him out. His argument, and I agreed, was his nurse did not consult him in a timely fashion. He blamed her for the whole fiasco. The only way he stayed out of litigation was to let her go. It was a shame.”
Dang it, I hate it took three lies to get this thing through. There was gonna be some powerful prayer time Sunday. I hope the Lord’s interpretation would be the means justified the ends.
“I suppose I could approve a standard treadmill without any documentation.” She was softer this time. Still a mean woman, though.
“No tickee. I gotta have a bailout nuke in case he can’t cut it- he’s pretty short of breath- he might not have the exercise tolerance to make the diagnosis. Boykins Douglas won’t pull the trigger unless he is not sure after the treadmill. You have my word.”
She hesitated. I waited. I almost played my next card and started to ask if Lori still worked there, but then she gave in. “O.K., Bibey. Your accession number is 5673-HYT- 685773.”
“Thank you ma’am, and you have a good day.” I’m glad I have honed my delivery as I’ve aged. I do not wish to cuss in front of women, or anyone for that matter, and it wasn’t needed to get my job done for the day. I’d go to church Sunday and ask for forgiveness for the stretches of the truth.
I burst out the door. Time to get back to work. “Hey Annie, get Dr. Douglas’s folks. Tell ’em I got their number.”
“Good work, boss. How’d you do it?”
“NAP, (bluegrass for not a problem) Annie. Turned out she was a bluegrass fan.”
“Well, I’ll be danged.”
Well, I’ve already told ya the end of the story. Snook flunked with ST segment changes in two and one half minutes, and the bailout nuke wasn’t needed to make the diagnosis. He did well with his bypass surgery, and still clips me for a burger most of the time. And good ole Dr. Bibey did go to church to ask for forgiveness. It was granted, and he lived to fight another day.
Next week, we’ll talk some about the Groopman hypothesis and chronic illness, then I’m gonna get back to music for a while.
Just remember to be aware that heart, and any acute illness for that matter, can be hard to figure. All you can ask of your doc, and yourself, is to try hard. None of us will be right every time. I hope to continue to dodge major calamity, and if I’m wrong on some smaller things, I’m gonna go down to the church house and ask for forgiveness. It won’t be the first, or the last time.
See you in a few days, and take care. Remember to hug your loved ones and stop and smell the roses along the way. Old Docs develop a keen notion of how precious life is and how quick it can change, so enjoy.