End Notes
A Waste of Time
A prescription for citalopram reveals much about what’s askew in health care.
By Jon Van Loon, M.D.
The patient first came to me several years ago newly abstinent from methamphetamines and committed to a sober and productive life. She had maintained sobriety through hard work and had developed a mature sense of responsibility related to her job. She recently had received a promotion and finally qualified for her employer’s health plan.
When she proudly marched into a local pharmacy to use her well-earned health care coverage to refill the medications that had, in no small part, played a significant role in her transformation into a responsible and productive citizen, she was told that the insurer would not pay for 80 mg of citalopram (three years earlier, an increase in her citalopram dose had facilitated the discontinuation of quetiapine, a considerably more expensive medication).
Of course, this refusal prompted my office to submit a prior authorization request, which took about 20 minutes of my nurse’s time. The prior authorization request was denied. That necessitated an appeal, which involved another 20 minutes or so of nursing time. Within a few days, we were notified that the appeal had been denied. The company provided an address and fax number where we could submit our secondary appeal.
After taking a few days to cool down, I opened the patient’s chart, reviewed her entire course of care, and drafted a letter that concisely summarized the rationale for prescribing citalopram above 60 mg. This process took about 30 minutes of my time plus time for a transcriptionist to prepare the letter. I wasn’t surprised to learn that my nurse then spent two more hours on this secondary appeal because the fax number initially provided was wrong. We still haven’t heard back from the insurer regarding the secondary appeal.
Physicians are routinely blamed for wasting health care dollars. Of course, the people leading the charge insist that the only way to control health care costs is through management of resources by the insurance industry. I am disgusted by the blatant disrespect many insurers show for our patients’ health and well-being, their time, and the time and resources of our clinics and practices.
The scenario I describe is not unique to my practice, that patient, or that day. It is repeated over and over throughout our state—and it needs to stop. MM
Jon Van Loon is a psychiatrist in Rochester and former president of the Minnesota Psychiatric Society.
A version of this article originally appeared in the June-July 2011 issue of the Minnesota Psychiatric Society’s newsletter “Ideas of Reference.”