Answer the phone already: A plea from doctors to managed care

The AMA is on record encouraging legislation that would set a much-needed maximum on how long physicians can be put on hold when they call managed care plans to appeal denials of care.

Editorial. Aug. 2, 2004.

As rocker Tom Petty once sang, "the waiting is the hardest part." That truism applies whether, as Petty, you're waiting for true romance, or as a doctor, you're waiting for a health plan's telephone hold music to be replaced by a human being so you can appeal for care the plan denied to cover.

The AMA has been directed to work on making those waits a thing of the past. At the AMA's 2004 Annual Meeting, the House of Delegates told the organization to "specifically encourage" Congress to write legislation mandating managed care plans to staff their physician-contact phone numbers concerning appeals for denied care so that the average wait time is no more than five minutes. That's way down from anywhere from 20 to 40 minutes, according to physician testimony at the meeting.

Thanks to a push by organized medicine, many states have legislated ways and timetables to mediate disputes between plans and patients -- with physicians often acting as the patient's advocate -- over insurance company's decisions to deny care. But the legislation the House of Delegates is pushing for seeks to eliminate the long waits in the office when a physician is trying, often with the patient in the examining room, to appeal on the spot for coverage of necessary care.