Why Do Insurance Companies Work Against Doctors?

October 14, 2016

If payors require patients to use particular businesses, it behooves them to ensure that these companies are doing their job and doing it right.

Gone are the days when physicians could write a prescription and the patient could go to the pharmacy and fill it without question. Now there are prior authorizations and step edits. Gone, too, are the days when one could order a test, the patient would schedule it, and it would be done. No, now you need a pre-certification. And, of course, the patient must use the in-network pharmacy and the in-network lab.

Now, what if the pharmacy staff is rude? What if they frequently make errors? Of course, the patient can go to another pharmacy of the same chain, but that might be in another town. Other businesses know that they need to step up their game so the customer doesn’t cross the street and go to the competitor. Chain pharmacies no longer have that fear. Mr. Smith has to use an ABC pharmacy. If the service is poor, he can’t go next door to the Whatever pharmacy because it’s not in network, and the next nearest ABC pharmacy is 10 miles away.

Same thing with labs. For years, we have been having a particular corporate lab make the same mistake over and over and over. And the same mistake is made in multiple drawing centers, so it’s not just one employee making the mistake. And after an informal survey of other endocrinologists, this is not isolated to our area. Physicians from California, Florida, Texas, and Arizona have had the same problem. I have spoken to supervisors. I have talked to the local rep. She said she would talk to the local supervisors but in the meantime, we need to change how we are writing our lab request. The other big chain lab doesn’t have a problem with our requisitions, neither do the hospital labs, or even the two smaller labs in the area, but we need to change what we do because this corporate lab is inept?! That was months ago. I try to write what they want when I know ahead of time that the patient is going to them, but I don’t always catch that. So the mistake still happens. It happened again today. So I asked the rep if she had gotten around to talking to anyone. She said she would (which means she hasn’t!!) but in the meantime, she again asked us to write their own special code on our slips. 

I would make my patients go elsewhere for their labs, but they are obliged to go to lab L and I am obliged to send them there. It is awful. It is a waste of time, energy, and healthcare dollars, which is exactly what I wrote to the insurance company that has contracted with this particular lab.

If payors are going to require patients to use a particular lab, pharmacy, or other facility, it behooves them to ensure that these companies are doing their job and doing it right.