Denied, by Jeffrey B. Nordella, M.D., with Kim Beyer-Johnson, softcover, 264 pp, $18.95, ISBN 978-0-9983892-0-2, Jeffrey B. Nordella, M.D., 2016.
This self-published book, a doctor's firsthand story, was for me more of a page-turner than the latest best-selling thriller. There's the heartwarming story of a boy born in poverty in Los Angeles, with probably no better prospects than one day being an auto mechanic, making it to medical school. It is a beautiful, tragic love story about his beloved wife and family. There are harrowing true-life medical stories from the emergency room and the scene of a terrible highway crash.
Dr. Nordella loves his patients and loves the art. He is just the sort of doctor you would want for yourself or your family--but just the sort of doctor that insurance companies do not want. Instead of being compliant and succumbing to burnout, he went to battle for his patients. He had a thriving solo practice in urgent care, until Anthem Blue Cross, which covered about 60 percent of patients in his practice, decided to destroy him.
This solo practitioner, with the aid of a solo-practicing, brilliant, intrepid litigator, Theresa Barta, fought this multi-billion-dollar giant through 14 years of litigation. Although you know from the blurb on the back cover that Dr. Nordella won an unprecedented victory, the book manages to maintain suspense throughout.
Both doctors and attorneys can learn something from the details about the legal battle and the trial. The conclusion I draw is that it is impossible for doctors to win in arbitration. Their only hope is to finally get before a jury. One also learns how the class-action suit against Ingenix almost crushed Dr. Nordella's hopes.
Interspersed in the book are passages written by the author's children and by Theresa Barta, giving an additional perspective on the events. I think the book would gain in professional credibility if someone were to fix the spelling errors, the dangling modifiers, and other grammatical atrocities, but nonetheless, the style is engaging.
One conclusion that I reach, although I don't know whether it has occurred to the author, is that patients should not continue turning their money and their lives over to any corrupt, rapacious insurance monster. The "insurer" first collected the patients' premium dollars, then it denied payment, and still worse, it convinced the patients that the problem was the doctor's fault for offering substandard or unnecessary care.
The situation will be familiar to all doctors who have endured Medicare or insurance audits: the unwarranted comparisons of a specialty practice or an urgent-care practice with a standard family practitioner's office, the unwarranted extrapolations, the endless demands for documentation, and the bureaucratic runarounds.
We applaud Dr. Nordella for his valiant battle and glorious victory. He did not, however, manage to put a stake through the heart of the beast. What we really need to do is to starve it.
Jane M. Orient, M.D.
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|Author:||Orient, Jane M.|
|Publication:||Journal of American Physicians and Surgeons|
|Article Type:||Book review|
|Date:||Jun 22, 2017|
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