On a scale of 1-5 ... How frustrating is this?

Like most American doctors, I take a variety of insurances and insurance plans.

Dr. Allan M. Block

Some of these, particularly HMOs, require a referring physician to send me a written, insurance-approved, referral (AKA authorization) before the visit, to submit with my bill.

Medical visits of all kinds are generally billed on a scale from 1 (brief/simple issue) to 5 (lots of time needed/very complicated).

After 23 years, I’m used to this.

But recently a new wrinkle has emerged.

In the last month I’ve gotten two referrals (both from the same internist), except these state, very clearly, that charges for any visit cannot exceed level 3.

And they’re telling me this before I’ve ever seen the patients, or have any idea how complicated they are, or how long a list of questions they and/or their families will have.

No.

I faxed them back asking for a referral allowing me to bill up to level 5 if needed. I might charge less than that, but none of us know how complicated or long a visit will be until someone comes in. There’s no crystal ball in medicine.

I’m sure someone will say I’m a money-grubbing doctor who couldn’t care less about the patient.

That’s far from the truth. I’m here for the patients. I like helping them. It’s why I do this.

But I can’t help anyone if I can’t afford to keep the office lights on, either.

I never heard back from them. Maybe they decided the patients didn’t need me that much. Maybe they sent them to another neurologist and took my name off their referral list. Maybe they never even noticed my return fax.

What will happen now, I have no idea. Maybe this was something that office tried, to see if I noticed. Maybe it’s the start of the next wave of medical cutbacks. Maybe it was a staff error at the other end.

But either way, none of us can see patients at a loss and hope to make it up on quantity. This isn’t an amusement park or thrift store. People with problems need time, and time costs money. I need to pay my staff, my rent, and my mortgage. If I can’t do those things, I won’t be able to help anyone.

That’s just, for better or worse, the way it is.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.