With the click of a Mouse - ThinnerTimes

Jennifer Miller · 11-30-2005, 10:30 PM

I really tired of waiting for this surgery.. There has to be a
better way.
Like putting everything on line.. in one database..
where all the insurance company's could access the infomation
at will.
This would mean.. Blue Cross, Pacificare, Sharp, Etena. etc could go to
Dr. Callery's data base and access our data in the click of an mouse.
This procedure of dictation is too slow. The whole damn process is too
slow..the uncertainy of approval and constant phrase"Depends on how
fast you get everything done." My insurance told me my first Phys date was
in January.. I got my interview with Kelly three weeks after I got my
ref#from my insurance company.I returned my paper work via car the
very next day. If this was on line .. Kelly would have the application with the click of a mouse. I believe this process is one of the reason some people
struggle so much after the surgery. The waiting and uncertainy leads
to anger... we all the know the rest... all you have to do read these
post to see the flustration. Once the decision has been made by your
primary , surgery should be within a sixty day period.
Surgery approvals or denials should be with a thirty day period after your first meeting.

It would go something like this.

A patient would go to Dr.Callery's Office for the first meeting.
Kelley would outline your tests on a screen.. They are sent to
Pomerado .Or whereever..But a place for all the test at once.
A Test Day..with Psyh evaluation.
Your tests,etc would be waiting for you at front desk.
All of your results would be enter into Dr.Callery's database.
Our Pysh. elvalution should be done at the same office.
Say Dr. Bryant.. she's cool.
She enters her evaluation into Dr.Callery's Data base.Not in two
weeks .. that day. When I got up to leave I asked,"Did I pass"
She smiled and said, "Yes Jennifer I will get this done fast."
Two plus weeks is not fast. I bet she says the same thing in
all her reports to Dr.Callery.
As a matter of fact all she would have to do is access the database
with my referral # and click on the words, "Approved" "Not Approved"
a simple radio button next to Phsy.in the data base is all that would be required.
In the click of a mouse.

One of Dr. Callery's staff confirms that all the test are finished.
including the education meeting, and support meeting.
With click of mouse all this infomation is sent via email(PDF)
to our insurance co's. all tied to original ref #from our
primary. To confirm anything all they would have to do is
access Dr.Callery's Data base. As for security. It's the
same information. The security is not a problem.
The person in charge of approval reads the file in Adobe PDF.
Prints it and puts it in your file. Redunant.. there are back up
services to make sure nothing is ever lost because of computer
failure.
With a click of a mouse the results is at Kelley's computer.
That results with a surgery date is email to you with a
date for preopt visit.
If you are turned down.."God Forbid" Kelley could email
the reasons and you could start your appeal process.

With the click of a mouse.

Maybe I don't have this all right.. but I do know.. Database is
the answer to curb sky rocketing insurance premiums.
The insurance companies function this way... its time for Doctors to
come in the 21st century..
If you doubt my thinking? Read

"The World is Flat" by John Friedman.

http://www.amazon.com/gp/product/cus...283155&s=books

Once last thing.. I bet you could do a couple of extra operations a
month with this procedure.. What would this do your bottom line?
Maybe a better total package could be worked out, saving money for
the insurance companies. I am not so sure they wouldn't fund this concept.
If you could increase your profits, lower costs maybe more people
could get this life saving surgery.
Thanks for listerning.. I've been wanting to write this for a couple of months.
Jennifer Miller

Oh.. I am not a database geek..imagine what a real
geek could do for your system.

http://http://www.amazon.com/gp/prod...283155&s=books

bridgetgirl · 12-01-2005, 10:20 AM

When did you go to informational meeting?

coptergirl · 12-01-2005, 11:17 AM

This is a great idea - I know there are computer databases out there for doctors, but they are so paper oriented because of the patients right to provacy and due to HIPPA. There is a lot of liability out there in sending stuff via email.

Believe me, though...I am in the pre-op pahse, and would LOVE for your system to be in place!!!

brookscn · 12-01-2005, 01:45 PM

I think a lot of the insurance "flaming hoops" are to make us change our minds...."if it's too hard, they won't do it - that's why they're fat" kinda logic. Well, guess what, we may be fat (some of us) , but we are also tenacious!

Approve my insurance request, Mr. Insurance Provider, or I'm gonna come SIT on you 'til you do!

bridgetgirl · 12-01-2005, 01:55 PM

Insurance carriers have 10 days to approve or deny, that isnt unreasonable to me.

All of the hoops we have to jump are a bit biased though. For example, if you need heart bypass, they dont make sure you have had irregular heart palpations for 3 years prior to approving, OR put you on a cholesterol and fat free diet AND make you show documentation of such as well as a documented fitness program for 6 months BEFORE they unclog those arteries.. you know what? This is complete justification for a class action lawsuit..... and I KNOW a lawyer

I wonder how these things come about... how ya get em started?

Realtor Linda · 12-01-2005, 02:16 PM

Not to be a nay sayer.....but remember there is man power involved. I get just as frustrated when things don't go as quickly as I want...but I am quickly reminded when I call to schedule an appointment and the gal who usually schedules is out sick. Or I go to the appointment and my nurse assistant is on maternity leave, or my x-ray tech broke his right hand playing baseball. The Insurance carriers are, by law, allowed 30 days from date of receipt to either pay or deny a claim. 30 days IS reasonable when you take into consideration all the paid holidays, vacations, sick day, slow days, PMS days, etc.....a law suit.....that is a little dramatic...don't ya think? Good luck with that one!

bridgetgirl · 12-01-2005, 02:19 PM

Is completely reasonable if you compare it to the example I gave previously. You dont have to jump hoops for heart bypass, but you do for gastric bypass. Both are based on medical necessity,and both are performed to stop to save lives. Why does one differ than the other, because of attitude. Its prejudicial absolutely.

Realtor Linda · 12-01-2005, 02:23 PM

Most people can survive 30+ days withougt having the WLS, most cannot survive without the heart bypass. With heart bypass, the constriction on the heart will not allow the patient to live. There is MORE TIME, sorry to say with a WLS patient than with a heart patient.

bridgetgirl · 12-01-2005, 02:31 PM

buuuuuuuuuuut how many MO people have died from respratory failure or heart attack. No one, not even if you are over 500 pounds and are going into respratory or heart failure will get gastric bypass stat to relieve them of their co morbidities. The later will, if a someone needs their arteries unclogged to get get their heart beating regular again you can believe its gonna happen ASAP.

We should start a new thread, I think this makes for a good debate..

Realtor Linda · 12-01-2005, 02:35 PM

i don"t disagree that it is a medical necessity for the MO, however, I come from a providers standpoint. It is NOT EASY meeting the 30 day deadline, let alone a 10 day deadline. I think, in my case, Pacificare did fabulously. Now, I am sure there are companies that may delay auth on purpose. Those are the companies who should be reported to the Insurance Commissioner....he regulates the carriers. I don't think a lawsuit is the right angle.