Asthma in children HOW TO TREAT, PAGE 25

Jimi Hendrix, jail time and life as a’ 70s doctor

NEWS REVIEW, PAGE 48

Treating tuberculosis THERAPY UPDATE, PAGE 44

An approach to amyloidosis

THERAPY UPDATE, PAGE 46

Dr Glaucomflecken issues warning to Aussie doctors.

claim denial in the past 12 months. You can appeal, but your chances of success are just 5 %.

“ This appeals process, as someone who’ s gone through it with the health

insurance company, is miserable. It’ s

Jamie Thannoo“ IF you’ re thinking about making a

impossible. It was impossible for me, and I’ m a physician.

change to your healthcare system,

“[ I ] can’ t imagine what it’ s like for

before you make that decision, ask

people who don’ t have any experience

yourself one question first.

in healthcare. It’ s very, very awful.”

“ Does America do that thing?“ If America does that thing, then don’ t do that thing.”

Dr William Flanary, better known as Dr Glaucomflecken, is back in Australia, last week appearing before the Royal Australasian College of Sur-

‘ This appeals process... is miserable. It’ s impossible.’

geons’ annual scientific congress.

He has become a cult figure to

But the black comedy for both

the medical profession here and

doctor and patient lies in prior

elsewhere, judged by his 2.5 million

authorisation— which seems to

followers on TikTok.

function like the PBS authority script

But the famed US ophthalmologist

line on a monumental scale.

did not just come with jokes, he came with a mission— warning Australia about the cost, waste, greed and immo-

Dr William Flanary, also known as Dr Glaucomflecken.

“ If you want to do gene therapy that costs $ 700,000 per treatment, yeah, you probably need to show

rality of a health system dominated by

proof that the patient actually needs

giant corporations making their profits

hospitals covered by your insurance,

“ I was taken to an in-network hos-

But he says managed care in the

that gene therapy,” Dr Glaucom-

through managed care.

but the fun starts should you venture

pital, but the doctors who worked in

US has other ways and means to

flecken acknowledged.

If you are fortunate enough to

beyond.

the hospital were out of [ network ].

reduce costs and inflate profits.

But prior authorisation is not

have a job in the US and are not on the

In 2020 for instance, Dr Glaucom-

“ You see, I made a mistake,” he told

The bluntest tool is simply deny-

just for rare procedures though, it is

very margins, you will be covered by

flecken had a cardiac arrest during

the audience.“ I didn’ t check first.

ing the claim.

applied to common tasks.

employer-sponsored health insurance.

his sleep. His wife performed CPR,

“ There is a toll-free number on the

The alarming statistic is one from

He said in 2022, provider Aetna

Under this high-cost system, you

with paramedics arriving 10 minutes

back of my card, I had no excuses.

a 2023 survey. Some 18 % of insured

backed down on its demand for prior

can go to any network of doctors and

later to resuscitate him.

Except that I was unconscious.”

adults said they had experienced

authorisation for cataract

PAGE 4

Antony Scholefield MORE than 5000 GPs are set to receive letters warning them about billing Medicare when either they or their patient is abroad, the RACGP says.

The latest episode of the Department of Health and Aged Care’ s mass mail-outs on Medicare compliance is targeting alleged breaches of section 10 of the Health Insurance Act 1973.

The section requires doctors and

patients to be in Australia when a Medicare service occurs.

The rule has not changed since 1984, despite the advent of widespread Medicare-funded telehealth consultations in 2020.

That same year, the department gained the power to match MBS data with Department of Home Affairs passenger records to identify possible breaches.

Official documents show that the department has continuously

cross-referenced MBS data with passenger records since August 2021 to track possible offenders.

‘ Has any crime been committed here?’

But the latest compliance campaign has prompted multiple doctors to ask whether the rule should change.

“ Help me out, please,” Dr Alan Wallace, a GP in Currajong, Queensland, posted on the Australian Doctor website.

“ My patient is away from home. She develops some symptoms and is not sure whether they are severe enough to warrant … seeking immediate care. She calls me, we discuss it and I decide she is okay for now.

“ The call lasts nine minutes and I complete all the nonsense necessary

to bill an item 91891. If both of us are in Canberra, that’ s okay.

“ If she( or I) are in Chicago, a crime has been committed?”

The AMA president, Dr Danielle McMullen, says she is open to a rule change, but said she was mindful of the risks.

“ Things like telehealth services based entirely overseas probably would not fit with what most doctors in Australia see as an appropriate standard of practice.”