Regular readers will know about my soap box and diatribes on the "prior authorization" process for medications, and increasingly, for imaging studies. In other words the hoop I must jump through with the insurance company to get my patient a medication or CT/MRI/US for my patient.
Yesterday I received a kick back from a pharmacy saying an insurers wouldn't cover a patient's medication without said prior auth. There was a phone number on the fax to call to get this. After reviewing the patient's history and deciding she probably would benefit from this drug, I said please to my nurse a half dozen times and she called this phone number. She told the person on the other end of the line what we wanted and they approved it. They didn't ask any additional questions and they wanted no justification. They just wanted us to call. The just wanted to see how motivated we were to jump through that hoop.
While I'm glad the medication was easy to approve I am still somewhat troubled by this. This prior auth process was set up to merely see if we would call. They banked on the fact that a large percentage of docs won't call and the insurance company will save money. Why can't it be the patient's responsibility to do this, or the employer that picked out the policy's responsibility to do this so they can see what the insurance company is up to?
Yesterday I received a kick back from a pharmacy saying an insurers wouldn't cover a patient's medication without said prior auth. There was a phone number on the fax to call to get this. After reviewing the patient's history and deciding she probably would benefit from this drug, I said please to my nurse a half dozen times and she called this phone number. She told the person on the other end of the line what we wanted and they approved it. They didn't ask any additional questions and they wanted no justification. They just wanted us to call. The just wanted to see how motivated we were to jump through that hoop.
While I'm glad the medication was easy to approve I am still somewhat troubled by this. This prior auth process was set up to merely see if we would call. They banked on the fact that a large percentage of docs won't call and the insurance company will save money. Why can't it be the patient's responsibility to do this, or the employer that picked out the policy's responsibility to do this so they can see what the insurance company is up to?
The Country Doctor