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“My due date was a week ago.”I had a patient come in to labor and delivery. She reported that she had received prenatal care in another state, and so she was assigned to me since I was taking unassigned call that day.She said she wasn’t feeling the baby move, and that her due date was a week ago. She was very insistent that she needed an induction of labor.I performed an ultrasound which showed a baby that was moving, but was measuring extremely small for a full-term baby.This could represent fetal growth restriction and poor oxygenation in a full-term baby. Growth restriction at term would be an indication to go ahead and deliver.But her story was confusing. She couldn’t give us a clear answer of exactly where she was getting prenatal care, which was a problem because we wanted to obtain and review her records.Ultimately we took a guess and called the nearby large tertiary hospital to see if she had ever been seen there. She had been. In fact she had been coming in every day complaining of contractions or bleeding or decreased fetal movement (there was never any evidence for this). She had been requesting for weeks to have a baby because she was tired of being pregnant.She was barely 32 weeks.Each time she had requested delivery, someone had explained the importance of not having a premature baby if possible and all of the medical risks that it would entail for the baby.So she decided she would try her luck at another hospital and tell them she was full-term.She was indignant and irate when confronted.If she had managed to convince us, her baby would likely have spent a month or more in the hospital, receiving multiple blood draws and IVs and oxygen, risking multiple chronic medical conditions for the duration of the child’s life, and could have even died. And this hospital stay would have been to the tune of multiple hundreds of thousands of dollars.I’d say that was a pretty dangerous lie.

HahahahahahahahaOkay, sorry about that. FFFFF**K the insurance company.The insurance company is a big, dark, opaque monolith that absolutely does not tell us what they pay for or what they do not pay for, and if so how much they pay for it, if at all. They like to make it a surprise.WANT THAT DRUG? Okay, try to prescribe it. Get rejected. They want some records to discuss if you get that drug. You send some information. It isn’t the right information. They WON’T TELL US which “codes” they will accept. We have to keep guessing, and keep trying. We have a full time nurse who pretty much wastes all of her full time job trying to wade through this neck deep bullshit.Want that test? Well you will have no idea how much it is going to cost you or whether your insurance will cover it until after it is done. And then if the company decides they don’t like the doctor’s documentation, they will refuse to pay it. But the hilarious thing is that we doctors have LITERALLY NO IDEA what they want documented. They don’t/won’t tell us. They like to make it a surprise.Over time, you can start figuring some of it out. But most of the time you can’t. Because your brain is actually full and “learning to code” is a full time job for normal people who have to go through training to learn about medical coding, like with classes and exams and stuff. But doctors have to simply guess and start coding. We are not trained in coding, and to learn it requires endless hours that we do not have. We want to spend those hours doing something else, like for example keeping up to date on actual medical information. Like we don’t have time for that, either, because we are all spending a couple of hours after work typing up your notes and reviewing your requests for denied care. What’s another 2–3 hours of unpaid work every night?Guess what your effing insurance company is doing. Can you guess? They are reading through your medical records trying to see if the doctor wrote enough buzzwords and clickboxes to get some code paid for. You thought this was private? Oh, think again.Whenever I order a test, I often have to shotgun a bunch of codes to them and hope it will “stick.” There is no “list of codes that they will take” for us to use as a guide.Just today I was trying to fill out a preauthorization with a battery of questions, like “will the patient die without this treatment?” and for some reason, there was no check box for “F*** YOU” which is what I really wanted to put on the form. Of course I am going to answer “YES” the patient will die without the treatment, even though who knows and most likely not but realistically if you say they might not die if they don’t get the test then actually I doubt they will pay for it.Please don’t blame your doctor.As you can see, just thinking about this scenario fills me with blind rage.WE DON’T KNOW WHAT CODES THEY ACCEPT AND THEY WILL NEVER TELL US BECAUSE THEN THEY MIGHT HAVE TO PAY FOR YOUR CARE INSTEAD OF PAYING THE CEO THE “AVERAGE SALARY” of 18 MILLION DOLLARS.FFFFFF them.

Even though medical information is protected by law, here in the US, many people are hesitant to have certain information appear in their record.It could be for any number of reasons, embarrassment, employment, or insurance. (Think alcohol abuse or addiction)Some fear that they will be treated differently. (Think AIDS or mental illness).If someone asked me not to include something, I didn’t.If it was something that other people could be harmed by not knowing, for example, you have HIV and you need surgery, I would, very neutrally explain, that the surgeons and nurses needed this information to prevent disease transmission to them.”Nothing is going on your chart but it’s important to make sure that your surgeon knows. They use different protocols to protect the staff, in that instance.”I was more than happy to leave things out but I wouldn’t lie. I’d just leave it blank.Oddly enough, the biggest fit that I ever heard a patient throw about this issue was with a colleague.He was sending her for evaluation for weight loss surgery. He had put “morbid obesity” as a diagnosis on her chart.She had not asked him to exclude it.But when she saw her records, at a later date, she blew a gasket. She demanded to have it removed.The doctor was a little taken aback by her vicious verbal attack.He apologized and removed it, as she requested, but she still called upper management to complain bitterly about being “shamed.”What can I say, we do our best. We don’t always get it right.Peace.