Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Saturday, August 11, 2007

Be Careful What You Wish For

From the comments:
If insurance ever decides to include [alternative practitioners], the story will be much the same as it is for docs and chiros.
"Alternative Care Preauthorization Center. Please hold for the next available representative. [20 minutes later] Hello, my name is Jane Doe, what plan are you calling for?"
  • United WealthScare.
"HMO or PPO?"
  • HMO.
"What procedure are you calling to precertify?"
  • Acupuncture.
"What is the traditional Chinese diagnosis?"
  • Stagnation of qi.
"What is the pulse quality?"
  • Full.
"What is the appearance of the tongue?"
  • Phlegmatic.
"How many meridians are you requesting preauthorization for?"
  • Ten.
"Electroacupuncture or dry needling?"
  • Electro, please.
"Estimate of needles required? Please round up to the nearest five."
  • Um, say fifty.
"How many treatments are being requested?"
  • Six.
"Thank you. Please hold. [20 more minutes later] I'm sorry. United WealthScare cannot authorize electroacupuncture for the stated diagnosis of stagnation of qi."
  • Well, what will they cover?
"Treatment of Qi Stagnation is limited to no more than four treatments per episode for up to six meridians, with dry needles only, unless there is documentation of pulse diminishment or tongue changes such as fissuring. Thank you for calling the Alternative Care Preauthorization Center. Have a nice day."



At Sat Aug 11, 07:43:00 PM, Blogger Lynn Price said...

Does United WealthCare cover readers wetting pants from laughing too hard? Hold please...

At Sat Aug 11, 11:14:00 PM, Anonymous Anonymous said...

As a former UR/appeals RN for United WealthScare, dead on.

Except for the hold time. You got off easy with 40 minutes for a response :)

At Sun Aug 12, 10:26:00 PM, Blogger Margaret Polaneczky, MD (aka TBTAM) said...



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