The Visit to the Dermatologist
Chapter 2, The Scam Behind The Curtain
However, on the day of her appointment, despite having filled out all of her information in the patient portal, it turned out that Dr. Skinman’s practice was not accepting UnitedHealthShare. Dorothy tried to calm herself down upon hearing this news. After checking to ensure that Toto was a certified service animal and thus able to join her in the appointment, she decided to pay cash for a visit with the dermatologist.
“Hi Dorothy, it's good to meet you,” said the doctor.
“I just wanna know what these terrible spots are!”
The dermatologist got out a magnifying glass with a special light, and looked at one spot on her body, then another, and then another. There were dozens of them.
“So you said you had a case of strep just a couple of weeks back?” asked the doctor.
“I get strep throat from time to time, but I take antibiotics.”
“Well, Dorothy, it seems you may have a condition we call psoriasis1.”
“Ruff!” barked Toto.
“Rough indeed!” agreed the dermatologist.
“My parents died when I was young, but I heard my father had psoriasis too.”
“Psoriasis is an autoimmune condition–it can run in families. In some people, it can be kicked off after a streptococcal infection– your immune system confuses your own body for the infection ever onward!”
“Well, I want to do everything I can to treat my condition!” Dorothy replied.
“There are a few more diagnostic steps we'll need to take. For example, some people don't just have psoriasis; they have a systemic problem in their whole body, joints, tendons, and skin. It is called psoriatic arthritis2. We want to make sure you don't have that.”
“Ruff! Ruff!” Barked Toto.
“We have a range of options, including ultraviolet light therapy3 for the rash on your skin.”
“Does that mean I'll be tan?” Asked Dorothy.
“You might be the first well-tanned person in Kansas!” replied the doctor.
“What else do we need to do?” asked Dorothy hesitantly.
“Well, this part is the rub, but we're gonna need to draw some labs, and I'll have to refer you back to your primary care physician.”
“Why do I have to see her? You're the expert!” exclaimed Dorothy.
“We want to get you out of the woods, but I'm a specialist. And you need a referral from your primary care doctor to see a specialist.”
“But you're a doctor? Why can't you refer me to the other doctor? Or to the tests?”
“Because your health insurance makes every specialist referral go through your primary care doctor.”
“Well, that doesn't seem right at all!”
“It's an effort to control costs… I think?”
“Why, what does all of this cost?”
“Well, the medicine you might need, it’s a biologic4 with an orphan drug5 classification. It’s hundreds of thousands of dollars. Just for that one medicine. You might need more.”
“Ruff grrr ruff!” growled Toto.
“I agree with Toto,” said the doctor. “Before you can get that medication, it needs prior authorization6. The best medication is only indicated for psoriatic arthritis with obsessionality. Right now, we only know you have psoriasis. We need to confirm the accurate diagnosis first, and a rheumatologist is required in order to make that diagnosis. Your insurance company won't cover the medication if any other specialist, even a dermatologist like me, tries to prescribe it. The medicine itself needs to be prescribed through a specialty pharmacy7.