Dr. Alan Nguyen

It makes my blood boil. It makes me livid that someone else is dictating care for my patients when they have never laid hands on my patients. They've never seen my patient or interviewed them or questioned them to see the severity of their situation.

I have to put out maybe 30 minutes to an hour or so, three times a week. I work in a very large office, so we have a prior authorization department that sends in most of the information when the insurance requests it. But I have previously worked in offices where the doctor does not have a lot of resources and can't hire all the staff to do that.

So they end up doing the majority of it, and the paperwork becomes very time-consuming.

A couple times a week, and it's becoming more frequent.

There's a procedure I can do to fix that fracture. It's called kyphoplasty. I put some bone cement in there and for the right patient, they're up and walking with 95% pain relief right after the procedure. They come in a wheelchair and they come out, they walk out of there, you know, smiling and walking just fine. And sometimes insurance companies won't authorize that procedure.

They say that the most common reasons would be that the patient doesn't need it, for instance, or it doesn't help, or it's experimental, or you didn't provide documentation to show that the patient has already tried X, Y, and Z before doing the injection.

I completely agree with them. I'm not trigger happy. I don't like to inject patients with needles and medications. If they can get better naturally, that's what I would prefer. That's what I would want for myself. I've had injections before. If I had gotten better with just therapy, I would have preferred that. It's always an option I offer.

But sometimes they're in so much pain, they can't do physical therapy. I've tried to prescribe it, but I can't force a patient to do physical therapy.

Sometimes it works and sometimes it doesn't because sometimes it doesn't matter what you tell them. I can show them all the studies that they requested to back up the procedure. And they might still say, oh, our company's guidelines, my employer's guidelines say that it's experimental and we cannot authorize it.

But if you're a doctor speaking to another doctor trying to do what's best for the patient, you shouldn't let the company dictate what treatment the patient gets.

I think it's complete bullcrap because the middlemen, the insurance companies, undermine the physician-patient relationship. These are things we didn't learn about in medical school. We were taught that we should always do what's best for the patient, and we don't have a choice here because we get compensated by the insurance company.

Not at all. Not at all. Because doctors complain about this stuff pretty often. We have Facebook groups where they post these kinds of stories all the time. But they're Facebook groups. They're private Facebook groups where you have to be a vetted physician to join. The public doesn't see it.

I think these complaints should be more public.