Medically Necessary, Now a Coffee

By Maryal Concepcion, MD, FAAFP · 6 minute read

There are two words every physician has said out loud more times than they can count, usually into a phone, usually to someone who has never met the patient. Medically necessary. MEDICALLY NECESSARY is a single origin Brazil Santos, medium roasted, with chocolate and mandarin orange in the cup and nothing sharp about it. This post starts with the phrase, then covers what is in the bag and how to brew it.

Why it is called MEDICALLY NECESSARY

The phrase is a password, and the door it opens should never have been locked.

Nobody trains you for this part. You spend a decade learning what a patient needs and then you spend a career explaining it to people whose job is to say no. The imaging. The referral. The medication that works, as opposed to the one that is on the list. Every one of them comes with the same two words attached, and if you say them wrong, or say them to the wrong person, the answer is a denial and a second phone call.

You say them to a person on a fifteen minute call. Lately you say them to a form that an algorithm reads before anyone does. Either way the outcome was decided somewhere else, and you are there to supply the phrase.

I have written on the About page about the year I was told to sign a production contract or be let go, at twenty eight weeks pregnant. I do not tell that story because it is unusual. I tell it because it is not. Somebody who does not see patients buys the place where patients are seen. A number appears that has to be hit by December. Medically necessary stops being a clinical judgment and becomes a line item somebody upstairs would rather not pay.

That is why I practice and advocate for Direct Primary Care: a physician and a patient, no middleman deciding what is necessary, and a practice the physician actually runs. In that model the two words go back to meaning what they meant in training. The doctor decides, and the patient is the only person who has to be convinced.

Dr. Matthew Hitchcock, MD, MBA, of Hitchcock Medical Group in Chattanooga, put the cost of the other way in one sentence on My DPC Story, episode 256, describing a patient in agony with a kidney stone whose insurer wanted seven to ten days to approve a CT:

"Well, if it's that urgent, just send him to the ER."

At his cash imaging center the same scan is done the same day. Listen to episode 256 of My DPC Story.

What is in the bag

Single origin Brazil Santos from Sul de Minas, grown between 950 and 1,100 meters, natural process, from Mundo Novo, Catuai, Icatu, and Bourbon trees. Medium roast.

The cup. Smooth body, chocolate, and a little mandarin orange. Medium acidity. It is the coffee equivalent of the thing you were asking for all along: obvious, uncomplicated, and not up for review.

The bag. 12 ounces ground or whole bean, and a one pound whole bean for the practice that goes through it faster than that. Roasted in frequent small batches based on customer demand, so it is not produced far in advance or held in storage.

The price. $22.99 for 12 ounces, $31.99 for the pound. Ships free at $50.

How to brew it

Drip. Standard grind, 1 to 16 by weight. The chocolate carries and the orange shows up at the end. This is the everyday cup.

Espresso. A natural Brazil is the classic base for a reason. Order whole bean and grind fine. Low acidity, heavy crema, no fight in it.

French press. Coarse grind, four minutes. The body goes heavier and the chocolate takes over.

Cold brew. Works well because there is nothing acidic to lose. Twelve to eighteen hours.

Who this coffee is for

The doctor who has said the words. Usually on hold. Usually to someone reading from a screen.

The nurse who has heard the call from across the room. They already know how it ends.

The resident who is about to learn. Nobody warns you how much of the job is this.

The person buying a gift for any of them. You do not need to know the joke to know the name sounds like something worth having.

Frequently asked questions

Is MEDICALLY NECESSARY a single origin coffee?
Yes. It is Brazil Santos from Sul de Minas, one growing region, natural process, grown between 950 and 1,100 meters. The roaster lists the varieties as Mundo Novo, Catuai, Icatu, and Bourbon.

What does it taste like?
Chocolate and mandarin orange with a smooth body and medium acidity. It is a medium roast with nothing sharp in it, which makes it an easy first cup for someone who says they do not like acidic coffee.

What does natural process mean?
The coffee cherry is dried whole with the fruit still on the bean, rather than washed off first. It tends to give a heavier body and more fruit and chocolate in the cup, which is exactly what this coffee tastes like.

Which size should I order?
The 12 ounce bag is right for one person. The one pound whole bean is for a practice or a household that goes through a bag in under two weeks.

What does "medically necessary" actually mean?
In insured medicine it is the standard a treatment has to meet before an insurer will pay for it. In practice it is the phrase a physician has to say, and often document, to get a test, referral, or medication approved that they have already decided the patient needs.

What is Direct Primary Care?
Direct Primary Care is a membership model where patients pay their physician directly, usually a flat monthly fee, for primary care. There is no insurance in the middle of the visit, so nobody outside the room decides what is medically necessary. Physicians tell their own stories of building these practices on the My DPC Story podcast.

How do I find a Direct Primary Care doctor near me?
Search The DPC Directory, a free listing of Direct Primary Care practices by location.

Does this shop make jokes about patients?
No. Nothing in this shop makes a punchline out of a patient or a diagnosis. The jokes are aimed at the system: the prior authorization, the hold music, the quota, the phrase you have to say to get the obvious thing approved. Real illness is not the joke. The machinery around it is.

More resources from My DPC Story

The My DPC Story Podcast. Three hundred episodes of physicians describing how they opened, grew, and run Direct Primary Care practices, in their own words.

The DPC Directory. Find a Direct Primary Care physician near you.

My DPC Story, episode 256 with Dr. Matthew Hitchcock. A physician who opened a cash imaging center so his patients never wait on an authorization for a scan. The kidney stone story is at 27:47.

Shop this coffee

MEDICALLY NECESSARY, 12 oz or 1 lb · from $22.99

Part of NO ROOM FOR PRIVATE EQUITY, THE SET, with NO PRIOR AUTH, PEER TO PEER, NO FINE PRINT, and OFF FORMULARY. Five things that do not ask you to justify anything.

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