CUTTING REMARKS
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plant. I hoped and prayed for approval. Not! A little too "experimental." Break
out the copper knee sleeve.
Peer-to-peer calls
I loathe the dreaded phone calls from insurers (also known as peer-to-peer
calls) regarding approval for a treatment plan. In essence, this scheme is to
facilitate a dialogue between the treating physician and the insurance doctor
(peer). Trouble is, my so-called "peer" is usually a 90-year-old retired proctolo-
gist who thinks "impingement syndrome" is constipation and whose favorite
drink is Metamucil. My last peer was so old she had an airbag on her walker!
The ER admission workaround
In the past when a surgery was necessary and the denial was imminent or the
patient was without insurance, you'd tell patients to come to the emergency
room to be admitted for their "emergency surgery." While appearing grossly
unethical, for many this was the only recourse for treatment. I once witnessed
the emergent admission and surgery for a non-healed stress fracture of the foot.
Must have really hurt! I guess failure of Dr Scholl's inserts justified approval. I
have even seen shoulder and hip arthroscopies expedited "urgently" through
admission via the ER. Lord knows how these patients got by the triage nurse.
This scheming will hopefully be no longer necessary as more and more
Americans gain coverage.
Worth the hassle
While I don't see an end in sight for the insurance gauntlet, I still get to help peo-
ple every day. And that, my friends, is still worth the hassle — even the dreaded
peer-to-peer phone call. Next time I hope my peer still has a license.
OSM
Dr. Kelly (
johndak 4@g mail.com
) is an orthopedic surgeon/ sports-shoulder specialist
who practices in Philadelphia, Pa.
