Raging Psychiatrist: Horror or Hero?

Giving the lie to the myth of the passive shrink, Washington psychiatrist Said Farzad, MD, according to media reports, threatened to shoot workers at Molina Healthcare and bomb their building during a telephone argument over whether the company would approve reimbursement for prescription drugs. In a video interview Dr. Farzad, apparently a contracted provider for the company, claimed anger-related amnesia for the conversations. Bothell, WA police arrested him on a variety of charges.

Predictably, comments on the Web either called Farzad a crazy psychiatrist or blamed Molina for stinginess.

When I contacted Molina for comments their marketing (!) representative did not answer my questions about what Molina workers did to provoke such a reaction, and whether the company contemplates in change in protocols, but instead provided a statement from Molina president Peter Adler:

“Molina Healthcare recently received a threat from a former provider over the telephone. Since then, we have been working closely with local law enforcement to ensure the safety of our employees, which is our utmost concern. We are not currently doing interviews or releasing specific details on this subject and ask that media inquiries be directed to the Bothell Police Department.”

I suspect Dr. Farzad represents the tip of an iceberg of rage among physicians fed up with abusive treatment by payers. I believe payers have a right to restrict reimbursement within the terms of their contracts, but typical “prior authorization” contacts involve excessive hold times, passive-aggressive reviewers who often have inadequate medical knowledge and little respect for physicians or their time (despite superficial politeness), and requests for information they could easily have obtained from the subscriber without involving the physician.

Rather than letting even justified rage ruin your career I suggest physicians

  1. Do not contract with payers.
  2. Always charge the patient for prior authorization calls.

I suggest payers obtain clinical information directly from the patient record, and leave the physician alone.

I predict abuse and threats directed to payer representatives will lead to increased efforts to protect reviewers, leading in turn to increases in the already bloated administrative budgets of payers and hasten the demise of the dysfunctional American system of medical care -- and the jobs of reviewers.

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