Preauthorization is a danger to your health
Some unlucky number of you may have already had to deal with the insurance company limiting or denying your prescriptions, medical procedures, tests or referrals based on an insurance clerical procedure called "preauthorization". This is a one of the many bureaucratic banes of my existence.
There is an article recently published by a writer who had gone through this dilemma, and provides his experience as well as some clarification of the "system". What I got from the article was that it is extremely complicated, unnecessarily so, and there is no way to get an adequate explanation from your insurance company. His recommendation was to bother the doctor. Bad idea.
To my dismay, there is now reports that Medicare, which had been blessedly free from preauthorization requirements in most cases, is thinking of implementing this procedure. Since seniors generally use more testing and procedures than the younger group (which has been abused by preauthorization by commercial insurance companies), this should lead to significant distress and delays.
Some of the disturbing results of preauthorization practices:
For prescriptions, when a prior authorization requirement is imposed, only 29% of patients end up with the originally prescribed product—and 40% end up abandoning therapy altogether!
The prior authorization processcan take 30-45 minutes for each submission. This is time the doctor's office does not have to see patients, process messages, return phone calls. so the next time you are on hold in our office, remember what we are doing for some insurance clerk.
For a submission to get authorized, approximately most physicians wait for at least one business day for a decision, and sometimes 3 or more business days, according to the AMA. During this time, patients are unable to start treatment.
How much preauthorization costs
Our office will generally decline to do preauthorization's for these reasons. We recommend that patients get on the phone themselves and hold their insurance companies responsible for their care which they are paying for.
