A Love Letter

This was a letter I wrote on the behalf of a patient to her medical insurance company. Now, maybe I'm naive enough to think that HMOs and insurance companies, while they do make a monetary profit, is genuinely there to help patients. But sometimes, as when this patient called me up crying because she was told her medication wasn't as necessity, I do wonder. The 'medical reviewer' who looked at her file said there were 'other' options. That she didn't need these pills and so they weren't going to pay for them.

This was my response.

Re: Denial of Calcitriol for PATIENT X

I am writing to appeal your denial of coverage for this patient’s Calcitriol. I disagree with the reason for denial, that this is excluded by this member’s plan.

This patient has post-surgical hypoparathyroidism. As any basic physiology textbook will show, parathyroid hormone is necessary to hydroxylate or activate 25-hydroxy Vitamin D to 1,25-dihydroxy Vitamin D, which is ultimately responsible for gut absorption of calcium. While most patients do not need Calcitriol as a form of vitamin D, in the absence of parathyroid hormone, patients with hypoparathyroidism cannot physiologically do this, even if taking massive amounts of over-the-counter Vit D. Therefore, the ONLY possible option, is Calcitriol. As you should be well-aware, there is no clinically available means of replacing PTH in these patients (the only recombinant PTH available is Teriparitide which is NOT used for hypoparathyroidism).

Not having access to this will lead to hypocalcemia which can be life-threatening. If your company wishes to be responsible any potential hypocalcemic seizures or worse for Patient X, please let us know and we will attach this in our medical records for her. If you wish for a refresher in basic calcium homeostatic mechanisms I would be happy to recommend a medical textbook. 

Yours truly,

Dr. Vagus 

I must say, I thoroughly enjoyed writing this letter. I had had some other frustrating insurance-related issues, and I happened to have some free time at work, so I vented my frustrations in a creative way. Sometimes I love screwing with these people.

We'll see if things get approved now. Damned greedy insurance companies. Sangchaimosifatt!