Managed Care Bloopers

I had to read it several times to make sure my imagination had not taken over:

"All pregnant women should be on generic Subutex (buprenorphine)."

This bold statement appears fittingly in bold letters near the top of a Columbia United Providers Follow up Suboxone PA Form.

I think they meant to say something like, "Pregnant women taking buprenorphine should not be taking Suboxone, the preparation that also includes naloxone." So why did they not say what they meant? The gaffs continued:

Substance abuse program the patient is attending? ________________________

That was a question? I think not. How about,

Current dose of Suboxone for PA approval?

Again, not a question. When you (patient? physician? bus driver? It does not specify.) sign, you agree that:

I have read the CUP Policy on Suboxone Treatment and attest that all criteria and limiting conditions have been satisfied. [followed by boxes for Yes or No]

Do we really need those boxes? For more fun the Policy statement follows. See if you can guess what the writer meant by "criteria and limiting conditions":

TITLE: Columbia United Providers Suboxone Therapy Policy

Is it not kind of Columbia United Providers to let us know that what looks like a title really is in fact a title. I kid you not. "TITLE" really appears at the top. Now follow the criteria and limiting conditions (apparently):

Patients will NOT be able to purchase their own medication during or after treatment.

Makes me wonder how they (we?) can stop them. Does the statement refer to all medication? I suspect it just applies to buprenorphine preparations.

Patients will also be required to have a signed pain contract that includes random urine drug screens.

Apparently just any old pain contract will do, provided it is signed -- by somebody. The contract has to include a drug screen. Do you suppose they mean that the contract must obligate the patient to submit to drug screens? And here I thought we were talking about treating addiction, not pain.

I'm starting to feel like Andy Rooney here.

Providers will need to indicate the type of narcotic that was prescribed prior to Suboxone: and mg dose.

There we see a novel (and gratuitous) use of the colon, but yes, we providers will certainly need to indicate that, and hope that we do not have to figure out who "prescribed" the heroin. I have no idea what they mean by "type of narcotic." If you can guess, please comment.

No patient will be prescribed more pills/day than they actually take

The writer probably could not decide whether to end that with a question mark or a period. Maybe they just did not want to assume that it was in fact a sentence. Think about how to comply with this "limiting condition." In my experience prescribing has to take place before "taking," so compliance could be a challenge.

Patients that violate their contracts with providers will not have their prescriptions filled.

OK, but pharmacists fill prescriptions. How can the physician or the patient commit to what the pharmacist will do?

I hope this will help CUP rewrite their agreement and policy, and give you a few laughs. The intention here is to mock, make fun of, and otherwise ridicule bureaucrats, legislators, executives, and just about anyone else who reveals their ignorance or stupidity with respect to behavioral health care or any other aspect of medical care by gaffs, bloopers, grammatical blunders, and malapropisms. I solicit your contributions which will soon collect on a page attached to this blog.

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