Some doctors who work or “moonlight” (i.e. work as consultants) are what I refer to as “physician ladies of the night.”
Ladies of the night?! Could she mean what I think she means, you ask? And this coming from a fellow physician?
Yes, I mean exactly that, but let me tell you the context: doctors (in our experience almost always psychiatrists) who work for insurance companies as consultants in order to deny treatment. They pretend to review facts of a child’s case, but they are in fact paid by insurance companies to save them money, not to save lives.
For example, today I received a so-called “peer-to-peer” call about a young patient of ours who had been in hospital less than a week before being stepped down to Kartini’s Day Treatment Unit two weeks ago. The insurance company denied her admission to the KDTU because, according to them, she did not meet “medical necessity criteria”. They wanted her discharged home. Now.
What did they mean “did not meet medical necessity criteria?” Mostly they meant “she’s not thin enough.” Well, that attitude is all very well for someone who knows nothing about mental illness, brain disorders in general or eating disorders in particular, but it is totally unacceptable in a psychiatrist. To anyone who treats eating disorders it is clear that a person’s weight is only one measure of how ill they are.
I pointed out the child had just failed outpatient treatment (pediatrician/nutritionist/psychiatrist) a scant three weeks ago and that, when not in our day treatment program, she is unable to finish her meals. That being the case, were we to discharge her, she would lose weight and wind up right back in the hospital! She is amenorrheic and only 89% of her pre-morbid weight (a new concept to this psychiatrist), so regardless of whether or not this “doctor” thinks she weighs enough, her body clearly does not.
I asked the psychiatrist whether, in his “expert” opinion, he had ever seen a patient with anorexia nervosa be treated successfully in just three weeks. He refused to answer. He repeated that she did not meet their insurance company internal admission criteria; when I asked him which ones, he said “you can read them yourself on the Web”. When I told him that I had his company’s criteria open on my computer, and wondered which specific criteria he was referring to, he refused to answer and simply repeated, “you can go to the Web”!
So this man, this supposed physician, denied access to care for a child based for no reason he could articulate, except the mantra the company had given him to repeat. He was successful at stone-walling this attempt by our patient’s family (who pay their premiums every month) to access benefits when they need them.
And do you know what? I believe he intended to say no right from the start. I could have saved my breath giving him clinical details.
Sometimes I have received calls from insurance physicians who are clearly driving in a car or out on the golf course. They do not have, and do not want to have, access to the patient’s chart. Why? Because that would require a true medical assessment of the facts and mostly they don’t give a damn.
We’re back again to the “give a damn factor.”
And if you think I’m mad, imagine being in the position of this family: unable to access care for your ill child on the say-so of an indifferent physician who is lady-of-the-nighting for an insurance company. Yes, that’s right. Go ahead and translate.
