Sometimes I wished things were simpler: You see a patient. You make an assessment based on clinical suspicion (and not have to order tests to 'rule out' something). You make a diagnosis and prescribe a medication (and not have to worry about the crazy costs, or have the insurance deny it). The patient is charged for your visit but if he cannot afford it you write it off (and not have to worry about getting sued by others for discriminatory charges).
Sad but true, that is the state of affairs now. I thought about this yesterday, from the patients I've seen this week.
I ordered a radioactive whole body scan for a woman. But her assurances of "I am not pregnant" was not enough for the radiologists; we needed to get a pregnancy test first.
I saw a patient with pituitary apoplexy with central hypothyroidism, growth hormone deficiency and hypogonadism with undetectable testosterone levels. I prescribed topical testosterone, only to have the medical director of the insurance deny coverage for the medication, claiming there wasn't enough biochemical evidence of low testosterone. 3 days later I'm still waiting to hear from him.
I think about the guy I saw for type 1 diabetes who lost his insurance and has to pay out of pocket. And how I had once been reprimanded by the legal/admin team to never underbill someone just because they have are not insured, as that will get us a lawsuit.
What a crazy world it's become.