PECing Order

Would you know what "PEC Questionnaire" means? I did not. Only in the second (of three) reminder letter did I see the words "pre-existing condition" and realize what this insurance company wanted: an excuse to deny or restrict benefits for an illness their subscriber might already have. Understandably, no insurer wants to take new subscribers who waited until they got sick to purchase insurance. Obamacare seems to promise to solve this problem by making everyone pay. We will see.

Let us look at the questions posed. The first seems reasonable enough, except that the insurer could find all that information in the medical record. (Although I do not provide coding services. Let them look up ICD-9 codes on their own dime.)

I have a problem with question 2. How can I know what prescription medications the patient "was using?" I know what I prescribed, but the insurance company (insco) could ask their subscriber what they used. Ah, but perhaps the insco does not trust the subscriber!

Question 3 crosses the line. Now the insco really seems to want to use me as a detective, and not only do they expect me to name names (which they could also obtain from their subscriber), but they want me to save them the trouble of looking up addresses of the physicians I list.

I appreciate the need to keep premiums low, especially for Regence which is my insco! (Is there a conflict of interest here?) But trust your subscribers and do not try to use me the physician as a snitch. Do you wonder what physicians do with their time? Inscos should work toward accessing this kind of information electronically via the electronic health record (EHR) and leave us docs out of this loop so we can spend time with patients.

Incidentally, Regence never pays me a penny on any claim, so providing this information would not have led to any reimbursement for my patient.

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