01/20/2026
If you’ve noticed I’ve been a little quieter here lately, it’s because much of my time has been spent behind the scenes advocating for patients with insurance companies.
A recent example: I saw a patient last fall for several concerns — some long-standing, others related to perimenopause. One of those concerns included low libido and difficulty with arousal. As part of her care, we ordered labs to evaluate thyroid function, night sweats, and fatigue. I also used a diagnostic code for hypoactive sexual desire disorder to help us better understand factors contributing to her symptoms.
She chose to run labs through insurance since she had met her deductible (often a mistake--cash-pay is generally more affordable). This week, she received a denial letter stating that none of her labs would be covered — not the thyroid labs, not the labs related to night sweats or fatigue — because of that single diagnostic code. Apparently female sexual dysfunction isn’t a covered expense.
The insurer explained they would reconsider coverage only if I remove the code, revise my clinical note to support its removal, and write a letter explaining why I “erroneously” used it in the first place.
This is why I don’t work with insurance.
They are not practicing medicine, yet they dictate how it’s practiced — creating delays, adding friction, and quietly discouraging thorough, thoughtful care. These hoops are intentional, and patients are the ones caught in the middle.
It’s not the easiest path, but it’s the one that allows me to care for patients the way I believe they should be cared for.
