A doctor has gone viral on TikTok with his wry critique of the health care system in the U.S., and its reliance on insurance companies.
Dr. Glaucomflecken, real name William Flanary who is an ophthalmologist in Portland, Oregon, posted footage to the video-sharing app on the topic of the current system of prior authorization on June 8, with the caption: “Explaining medicine to your non-medical friends.”
Prior authorization is a cost-control process in which medical professionals are required to obtain approval from insurance companies, or health care providers, before offering a service to a patient.
This is done in order to check that the test, treatment or procedure qualifies for coverage.
In the clip Dr. Glaucomflecken, who describes himself as a comedian, is dressed in scrubs and in a plain blue T-shirt. The video is cut in such a way that it looks as though he is two people having a conversation—one a doctor, one not.
It begins with the doctor character telling the friend that he had been doing “prior authorizations all afternoon.”
When he is then questioned on what this entails, the doctor answers: “Well if a patient needs an expensive test or treatment, we have to ask the insurance company if they’ll pay for it before we do it.”
He is then challenged: “Why? You’re the patient’s doctor.”
The medical professional replies: “Well, they want to make sure I’m ordering something the patient actually needs.”
Perplexed, the friend persists: “Oh so you’re talking to another doctor that has your level of expertise?”
When he sheepishly retorts that the person usually “didn’t go to med school,” the friend is in disbelief that, potentially, a patient “can’t get the treatment that you, their doctor, recommends.”
He goes on to say that these insurance companies are “practicing medicine without a medical license” and that “if insurance denies it then the patient won’t get the treatment which means they won’t get better…
“Or the patient will get the treatment anyway but be financially devastated by it.”
He also adds that this “could lead to even more mental and physical health problems that don’t get treated.”
Glaucomflecken, playing the doctor, then reluctantly agrees, and in the role of the friend he then says: “Either way, the insurance company is making medical decisions that directly impact the health of the patient…Which is also known as…
“Practicing medicine,” the doctor responds by finishing the sentence.
The video has so far been seen by 653,300 people on TikTok, where it received 139,800 likes.
Glaucomflecken also shared his video to Twitter, where many people have taken to the comments section to share their thoughts.
Doctor Kelly Wright, known online as @MigsRunner, wrote: “The only inaccurate part is saying prior auths are for ‘expensive’ tests or treatments. Literally they’ll block anything, even ibuprofen.”
An account by the name of @sweetandsnark added: “I had been on the same anti-depression med for 7+ years and at random times they’d deny my refill because they’d only pay for 1 tablet.
“My daily dose doesn’t exist in one tablet, I had to take 2. And that sent me into horrible withdrawals while they figured it out.”
Whereas @chilldenied commented: “Equally frustrating when doc says ‘Ideally… but your insurance won’t approve it.’
“I do NOT want to know that you are making medical decisions about my care based on what you fear will happen with the insurance company. Give me the choice. Try first. We’ll go from there.”
However, some were skeptical of the video, with @Commando26V writing: “This is fairly disingenuous. PA is done when there is typically a cheaper alternative.
“The PA rules are developed by doctors and clinicians using their experience from the field so the rules are medically based. Insur companies know they are cumbersome so it’s used sparingly.”
Newsweek have reach out to Dr. Glaucomflecken for comment.