Having just completed my teaching obligations on the consult service, I was looking forward to a relaxing long weekend break. Driving along the I-93, heading north towards New Hampshire and beyond, I was in a fine and festive mood. That is, until I made the mistake of checking to see whether that latest ping sound emitted by my iPad was trumpeting the arrival of an e-mail message from my secretary. I suffer from device overload syndrome, a disorder where these techno sounds stimulate a sudden urge for those afflicted to immediately stop whatever they are doing and read the latest message. This one was notifying me that the new patient I had seen just a few hours earlier, the one for whom I ordered an MRI study of the hip, was being denied this test until I could explain my clinical rationale to a representative of her health insurance’s radiology benefits management company.
I guess I shouldn’t have been surprised that an inexperienced office clerk might not have followed my logic for ordering the test. Would they simply stare at the words on the form describing the bare facts of the case? A lovely 38-year-old woman from Maine with active rheumatoid arthritis and chronic kidney disease suddenly had problems walking. I had written my differential diagnosis (septic arthritis, avascular necrosis) in legible big block letters and forwarded a copy of her X-ray report, demonstrating normal appearing hips. Yet all this effort was to no avail; the benefit managers were not appeased. So, with my spouse taking over the driving duties, I called the company’s toll-free line. A pleasant woman answered and immediately asked for some demographic information. Sure, I replied. I provided the patient’s name and the 8-digit number assigned to this case. “Well, can I have her date of birth, too?” “Are you kidding?” I replied. “Isn’t the information I just gave you sufficient to identify her?” I explained that I was not in my office, but the clerk could not seem to care. Then she uttered one of the most overused eponyms in healthcare: “Doctor, HIPAA rules require you to provide me with her date of birth.” What could she be thinking? Yes, Dr. Helfgott, even though you knew the patient’s name, her approximate age, state of residence, and 8-digit case reference number, perhaps you just guessed correctly? I still need another way for you to confirm her identity or we cannot continue this conversation. She didn’t actually say all this but she must have been thinking along these lines.