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Prior Auth. WTF?!?

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  • Prior Auth. WTF?!?

    So im an inpatient doc and rarely do prior auths. Either my residents take care of it or once every few months I jump in. Today i jumped in. What is the point honestly? I call them, it takes about 45 minutes of my time and a secretary just approves it. I have to give my info at least 3 times over and at the end I question why i am in medicine. I try and see the benefit, but every time it is just a drain on my mental well being. How is this real life?

    End rant

  • #2
    Originally posted by Bdoc View Post
    So im an inpatient doc and rarely do prior auths. Either my residents take care of it or once every few months I jump in. Today i jumped in. What is the point honestly? I call them, it takes about 45 minutes of my time and a secretary just approves it. I have to give my info at least 3 times over and at the end I question why i am in medicine. I try and see the benefit, but every time it is just a drain on my mental well being. How is this real life?

    End rant
    I appreciate the gate-keeping on the side of the insurance companies.

    It keeps my premiums low and healthcare inexpensive.

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    • #3
      The 45 minutes is exactly the point. To annoy you into not doing the auth in the first place

      Comment


      • #4
        Originally posted by childay View Post
        The 45 minutes is exactly the point. To annoy you into not doing the auth in the first place
        100%. Every aspect of insurance is to add in a gate/friction to reduce the likelihood due strictly to attrition things get completed. Its so plainly the business model it should be made illegal.

        I cant believe you try to see the benefit, you're a good person.

        The actual benefit is your patient gets something they need, but its pointless as an exercise.

        Comment


        • #5
          I wonder how much insurance would cost if everything were just covered.

          Comment


          • #6
            Originally posted by burritos View Post
            I wonder how much insurance would cost if everything were just covered.
            I wonder how much health insurance would cost if it were more like an auto policy. (Sorrrrry, the cost of repair is worth more than the car!)

            Comment


            • #7
              Originally posted by burritos View Post
              I wonder how much insurance would cost if everything were just covered.
              Well certainly HUM and UNC stocks wouldn't be at record highs as they are currently..

              Comment


              • #8
                Originally posted by childay View Post
                The 45 minutes is exactly the point. To annoy you into not doing the auth in the first place
                That’s EXACTLY the point. I won’t do peer to peer calls for a PA. I’m not spending 45 minutes of my time on the phone because you have crappy insurance. If it takes more than 10 seconds to fill out a form, I’m not doing it, and you can either pay cash for it, or come in for an appointment to discuss other options.

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                • #9
                  The loss ratio, or what is deemed as a loss ratio, for the ACA mandate motivated insurance companies to pull two levers to increase profitability - increase premiums, and annoy the $hit out of doctors with this stuff and allocate these things under "quality improvement". Take solace in the fact that you are getting a small share of these profits in VTSAX.

                  Comment


                  • #10
                    I usually don’t do them. But I do , I add the time I to the patients bill

                    Comment


                    • #11
                      If I have a PA that is not going through, I do the peer-to-peer on speaker phone with the patient present. I remind the physician on the call that it my state [Kansas] he may be subject to state law and may have initiated a doctor-patient relationship.

                      I have yet to have a PA for med or radiology not go through when this tactic is employed.

                      Comment


                      • #12
                        Originally posted by runfast00 View Post
                        If I have a PA that is not going through, I do the peer-to-peer on speaker phone with the patient present. I remind the physician on the call that it my state [Kansas] he may be subject to state law and may have initiated a doctor-patient relationship.

                        I have yet to have a PA for med or radiology not go through when this tactic is employed.
                        This is pretty showy and dramatic.

                        Nobody ever loses peer-to-peers. It is not the speakerphone part that helps you.

                        ...as was said, the PA and P2P are just hurdles and delay tactics that the insurance hopes the doc and patient will decide not to do so they can keep the cash. Denying codes, paperwork, requiring referrals, delaying tests or Rx, etc are all the same... they hope the person will give up, get better, or might even literally die in the wait or review time. No joke. Tale as old as time.

                        Comment


                        • #13
                          Heres my beef. So when i finally got to speak to the right person, it was a secretary not a doctor. I told her it was urgent that the pt got the meds(oxy for new diagnosis of cancer pain) and within 1 min she goes, approved! no discussion, nothing. I didnt even explain why the patient needed the oxy. She just said ok. It made no sense. This process was just built to annoy the F*** out of me.

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                          • #14
                            I had a patient that used to work for one of the big insurance companies. Made 7 figures + bonuses depending on how much money they saved by blocking stuff. It was sickening when they told me about it, and likely was just the tip of the iceberg.

                            Comment


                            • #15
                              Welcome to the problem of outpatient medicine when the insurance company isn't the patient's friend...and you are a creditor trying to collect (in the view of the insurance company).

                              I seldom do p2p. I have our sec schedule a time for p2p be available for three way call with patient and telehealth visit to bill for time. Rarely gets to that. Company asks for more information to resubmit and gets approved.

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