Mrs. Cassidy slowly walks into my office one busy afternoon. I see her out of the corner of my eye because she is hard to miss. Mrs. Cassidy has some serious style. She has a deep orange dress with a bright blue blazer on. There aren’t too many folks that can pull that outfit off, but she can. She has a wide slow smile, and she speaks with a slow southern drawl that belies her southern roots. This was supposed to be a routine follow up visit for a 67 year old woman with a history of a mechanical mitral valve replacement and coronary disease.
Unfortunately, she tells me a story that is concerning for angina. I think she needs a stress test. I slide over to the insurance tab on the EMR and I let out a somewhat audible groan. She has a Medicare Advantage (MA) plan. I explain to Mrs. Cassidy that we will need to go through an extra step to pre-certify her stress test. She expresses surprise and asks me what she should do. I will tell you what I told her, but first, let me tell you why.
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