The trials and tribulations of the modern health care system even effect small towns like mine. I have patient at the local nursing home who has been developing some trouble breathing, cough, and fever for the last couple of days. Yesterday I contacted the family to see how aggressive they wanted to be in the treatment of a probable pneumonia for this patient with very advanced dementia related to multiple strokes. The declined transport to the closest hospital, but requested everything be done within reason at the nursing home. Between all out aggressive treatment and letting "old man's friend" take its course, this seemed like a very reasonable middle ground.
I ordered a chest x-ray and blood count to confirm my diagnosis and ordered some antibiotics to presumptively treat the pneumonia. Sure enough, the x ray came back today and confirmed what I had suspected--an infiltrate in the right lower lobe of her lung. What I didn't expect was that the insurance company--Silver Scripts--would not approve the medication I had ordered; a medication called levofloxacin which is a fairly standard treatment for pneumonia.
My nurse got on the phone to call the insurer and got nowhere. I'm a pretty mild mannered person, but this just got my dander up. I got on the phone and asked some high school grad behind a computer to justify her medical decision. The only reply I got was that I could write a letter of appeal to which I would have a reply in 72 hours. To this I replied, "Well she might be dead by then!"
The insurer sent us a list of medication they would approve and we found one that I hope will do the job as well as the antibiotic that I, the patient's physician, had selected. Who says insurance companies don't practice medicine?