Denial of care saga, part 3.
Concierge for @AnthemBCBS reached out, very friendly. Talked to MD reviewer (adult internist) who said, yeah, makes total sense, but I am a Level 1 reviewer and can't approve your request. 🤦♀️
Level 2 reviewer (peds GI) cannot be called directly. 1/x
Concierge for @AnthemBCBS reached out, very friendly. Talked to MD reviewer (adult internist) who said, yeah, makes total sense, but I am a Level 1 reviewer and can't approve your request. 🤦♀️
Level 2 reviewer (peds GI) cannot be called directly. 1/x
https://twitter.com/DrLaurenWilson/status/1569515352887029760
Patient's peds GI stayed in the office until 11:00 pm last night finishing a multi-page letter of evidence & justification and attaching additional clinical documentation. Sent it off.
And ... now we wait?
Meanwhile this child is on high dose steroids with no endpoint. 2/x
And ... now we wait?
Meanwhile this child is on high dose steroids with no endpoint. 2/x
My colleague says there is a national peds GI listserv replete with stories of patients just like ours, including stories of people dying while waiting for approval.
The longer we wait, the greater the risk that our patient will need a surgery to deal with her inflammation. 3/x
The longer we wait, the greater the risk that our patient will need a surgery to deal with her inflammation. 3/x
So, @AnthemBCBS, I am once again asking you to let us treat our patient.
I don't care if your "concierge" is apologetic and nice.
I just want you to stop interfering in her care.
#FixPriorAuth @AmerMedicalAssn
I don't care if your "concierge" is apologetic and nice.
I just want you to stop interfering in her care.
#FixPriorAuth @AmerMedicalAssn
Bonus - references from the appeal letter. We are asking for a 10 mg/kg dose due to the severity of her illness.
Enough evidence for you, @AnthemBCBS?
Enough evidence for you, @AnthemBCBS?
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