I Came In Like a Wrecking Ball

I have to start by warning you, dear reader, that I am writing my first editorial for Practical Dermatology immediately after typing up four appeal letters to insurance companies. I was an English major in college (Go CU Buffs!) and I joke that it prepared me to write strongly worded masterpieces to combat the nonsense that insurance companies are putting us through.

I have it down to a science. I take three sips of a caramel Frappuccino (oat milk, no whip if you’re buying) and I start my “get pumped up” play list, which includes hits like “Roar” by Katy Perry, “Wrecking Ball” by Miley Cyrus, and “Look What You Made Me Do” by my beloved Taylor Swift. Once I feel the caffeine coursing through my veins and the inspirational tunes hit my ears, I’m ready. I cozy up to my laptop and I let it rip.

I know that you attract more bees with honey than with vinegar and so I’m nice. I’m friendly. I’m a peds derm, after all, and we are known for our ever-present sunny disposition. But I’m strong. I’m straightforward. I’m a shark. Maybe a baby shark, but a shark nonetheless. 

The whole process is a big pain. Why do they put us through all this? Well, that’s easy: denying meds saves them money. And they have statistics showing that most clinicians give up and choose a different path when faced with a denial. But we need to turn the tables. When we file an appeal, that costs them money. When we request a peer-to-peer review, that costs them money. When we request an external review, that costs them money. By taking my appeals to the next level, I am trying to show them that saying YES would be cheaper than saying NO. I also believe that we should pursue legislation that would allow us to charge insurance companies (the companies, not the patient) for the time that we spend in navigating their absurd drug coverage pathways. If they were going to be charged an hourly fee for our time, maybe things would suddenly become much easier.

It’s clear that all of this sucks our time, our energy, and our passion. So why do I fight? Well, I did my dermatology residency at Mayo Clinic, where the motto is “the best interest of the patient is the only interest to be considered,” and I have carried that with me throughout my career. I fight because I will never be OK with substandard care for my patients. I fight because “the only thing necessary for the triumph of evil is for good people to do nothing.” I fight because clinicians are the only ones who truly have the patient’s best interest at heart. 

The recent assassination of the United Healthcare CEO brought the title of a 2010 book into the public conscience: “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It.” I think we need our own motto. I propose: Appeal. Advocate. Achieve.

So get out there and fight for your patients! As Miley says, come in like a wrecking ball!