Breathe first. Ok.
So I have a patient whose husband is currently serving active duty abroad and has done so for umpteen years. She is covered by Tricare. Till now, it has been acceptable. Perhaps heavier on paperwork but otherwise fine.
Unfortunately, my patient developed a serious liver condition. She began by seeing a local gastroenterologist but when her condition began to deteriorate, I wanted her to see a specialist in liver diseases aka: a hepatologist. I happen to know a great one from my training at Jefferson. I called Dr. R who was willing, happy and able to help my patient. All good.
Then Tricare steps in.
My office spent two weeks and countless hours trying to get Tricare to approve this consultation. Finally, I stepped in and called —admittedly beyond pissed.
I spoke to four people over forty minutes. And here was the hang up. No, not that the visit wasn’t necessary or appropriate or that the doctor was not in network or that the treatment wasn’t approved by the FDA.
According to Rashida, Annette, Roger, and Madhu, my very sick patient couldn’t see Dr. Rossi because a “hepatologist” was not on the list of Tricare providers. As in: hepatologists don’t exist. Anywhere. Because they aren’t on “the list.”
As my blood boiled and my hands began to go numb, I found myself saying the following to the last poor soul on the phone”So, you are saying that my patient Ms. ____, is probably going to die because Dr. Rossi, who has a wall full of certificates and degrees from accredited medical institutions in this great country that has been served selflessly by this family, is not recognized as a specialist on your %^&***&^%^ list?
No exaggeration: 30 minutes later, there was a faxed approval letter in my office.
Now, consider this. Dr. Rossi charges say $200 per consultation. If I add up the total payroll hours my office spent, plus the 40 minutes of my time and the copay for the Xanax I needed that day, I would have been better off paying for the consultation myself. There is something very wrong with that.