Neil H. Baum, MD, presented “Practice Management Advice for the Urologist: Advocating for Your Patient” for the Grand Rounds in Urology audience in September 2021.

How to cite: Baum, Neil H. Practice Management Advice for the Urologist: Advocating for Your Patient.” September 2021. Accessed May 2022. https://grandroundsinurology.com/practice-management-advice-for-the-urologist-advocating-for-your-patient/

Practice Management Advice for the Urologist: Advocating for Your Patient

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, considers how and why physicians should advocate for their patients in the face of insurance claim denials. He explains that denials occur because rejections lower costs for insurance companies and allow them to hold money for weeks or months as appeals take place. Dr. Baum then tells the story of Shelly (name and likeness used with permission), a patient of his with cerebral palsy. Shelly used a voice synthesizer (VS) to communicate, but the school board refused to allow her to keep the VS once she graduated high school. Dr. Baum describes how Shelly’s family requested a new VS from their insurance so that Shelly could attend college, but were denied on the grounds that the VS was a “creature comfort” and the insurance company was “not responsible for replacing something not present at birth.” Dr. Baum decided to serve as Shelly’s advocate, reaching out to the state insurance commissioner, the insurance company’s medical director, government representatives, and the media. As a result of this advocacy, the medical director approved coverage of the VS and Shelly was able to go to college. Dr. Baum summarizes what he learned from this experience, highlighting the power that physicians have to help their patients, but also noting that they cannot advocate for every patient since the process is too laborious. He concludes that insurance companies are focused on their bottom line, so physicians must be focused on the welfare of patients.

For more commentary on practice management from Dr. Baum, visit his Improving Your Urology Practice page.