I'm trying to be more duckish, to let things roll off me and to slow life down, just a little. There are so many people with so many problems, and so many bad things going on in the world, it seems I shouldn't get bent out of shape about things that really don't matter.
Having said that, I snapped at someone today over one of those little things that just shouldn't matter: Getting pre-authorization for a medication for a patient.
First, let me say that some of this is my fault. I hate my fax machine and I just haven't bothered to replace it. It spams me with roofers and $99 Disney World offers, and repeat requests for medication refills when the patient long ago stopped taking the medicine. The memory empties if the machine gets turned off or the power blinks, and it often prints the same document repeatedly. It prints documents one at a time and I often need to stand over it to get them. The day I stood there waiting for it to print out 11 requests from the same pharmacy, for a refill for the same medication, I had a revelation: I could become a doctor who won't fax. I turned off the fax machine and it is no longer a part of my daily life. On rare occasions, when there is no option, I turn it on. But mostly it's been a big relief. Other people don't return phone calls. I don't fax. We can email pdf files, and if I need to get a document to a patient, I take a photo with my phone and text it to them. If that doesn't work, the phone has a scanner and I can email documents. Why would I need to stand over a fax machine? It's also my fault because I don't have a secretary to do these things for me, but that would come with it's own set of things to take care of.
So today I got a call from a pharmacy. I wrote for a high dose of a medication, it needs preauthorization. I'd need to call an 800 number to get that preauthorization. They forgot to leave the patient's insurance number. I called back, got the insurance ID #, then called the insurance company and began the arduous process of voicemail menu hell to get the right authorization form. Somehow, I was led to a live person, who kindly offered to do the pre-authorization over the phone, but then said it couldn't be done for this medication. It had to be faxed. They'd fax the form, I'd fill it out and fax it back. There were no options.
I went to the dreaded fax machine, during which time the insurance company put me on hold. I waited. Then I waited for the fax and it didn't come. She tried again and it still didn't come. I figured my machine just wasn't working and I asked if they could email it to me. They can't. Why? It has patient information on it, sending it on email would be a HIPAA violation. I asked about sending the blank form that I could fill out (I now had the insurance ID number). They don't do that. It's a HIPAA violation to send email, but faxes to a office where who-knows-who might see it, or wrong numbers might get dialed, or the wrong doctor with the same name could get sent the information (..with my last name, I get other people's faxes), happen all the time. I asked if the blank form was on a website. It was and she gave me the insurance company's general website. I knew -- from previous experience-- that I'd never be able to find it from there and asked for the exact URL. She couldn't give me that and instead offered to give me another 800 phone number where I could call to ask for the URL of the form. We were at 20 minutes of this -- in a time where there is no excuse for not being able to easily transmit a form to someone -- and I snapped at her and hung up. I'd deal with it on Monday. And then, of course, the form came through.
The form was already filled out. There were check boxes for the indications why one might need a higher dose. I check one. There was a question about whether a specific other medication had been tried. It had been, do I checked yes. And I faxed it back. Two check marks -- now why couldn't they take this information over the phone? Or why couldn't the form automatically have been sent to me when the patient handed in the prescription, without the pharmacy intervening to call me to tell me I had to call the insurance company to request the form be faxed to me? Oh, never mind, that would not have worked because my machine was off.
I suppose it bothers me because it feels like an unnecessary waste of time that is purposely engineered to be that way.