Answer the phone already: A plea from doctors to managed care

The AMA is on record encouraging legislation that would set a much-needed maximum on how long physicians can be put on hold when they call managed care plans to appeal denials of care.

Posted Aug. 2, 2004.

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As rocker Tom Petty once sang, "the waiting is the hardest part." That truism applies whether, as Petty, you're waiting for true romance, or as a doctor, you're waiting for a health plan's telephone hold music to be replaced by a human being so you can appeal for care the plan denied to cover.

The AMA has been directed to work on making those waits a thing of the past. At the AMA's 2004 Annual Meeting, the House of Delegates told the organization to "specifically encourage" Congress to write legislation mandating managed care plans to staff their physician-contact phone numbers concerning appeals for denied care so that the average wait time is no more than five minutes. That's way down from anywhere from 20 to 40 minutes, according to physician testimony at the meeting.

Thanks to a push by organized medicine, many states have legislated ways and timetables to mediate disputes between plans and patients -- with physicians often acting as the patient's advocate -- over insurance company's decisions to deny care. But the legislation the House of Delegates is pushing for seeks to eliminate the long waits in the office when a physician is trying, often with the patient in the examining room, to appeal on the spot for coverage of necessary care.

Waiting is a problem that knows no geographic or specialty boundaries. Slightly more than 13% of the complaints received on the Health Plan Complaint Form, run by the AMA's Private Sector Advocacy office, have indicated that "extreme hold time" when contacting a health plan is a reason the complaint was filed.

At the AMA's Annual Meeting, the resolution regarding excessive waits stated that hold times of 20 minutes or more were common when calling health plans. One physician told some of her fellow delegates during a committee meeting that 38 minutes is her average waiting time -- and she still might end up with someone saying they can't help her.

Like the proverbial butterfly who flaps her wings in China and causes a hurricane on the other side of the globe, the delays have an insidious and dramatic effect on physicians, staff and patients. The problem of the long wait is that, as the resolution pointed out, it prevents physicians from delivering timely care in their offices.

The long waits also make it difficult to maximize care for the patient in question, and may make it difficult to appeal a denial of care. Residents and fellows, the resolution notes, often experience the same delays with medical clinic patients who have managed care plans.

If physicians are holding the phone, not knowing when someone is going to pick it up, that takes time away from treating not just the patient who's the subject of the appeal, but every patient who has now been delayed because the appointment is running long. If staff waits on the phone, that's time taken away from their usual tasks.

And, of course, patients are ill-served by plans who don't have the wherewithal, despite their profits, to pay for enough staff so they can get at least some answer in a timely manner.

Physicians, their staffs and their patients deserve better, and that's why the legislation has been proposed. The waiting may be the hardest part, but that doesn't mean it has to be the longest part, too. What physicians are saying to health plans is neatly summed up by another Tom Petty lyric -- "don't do me like that."

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