Getting around pre-authorizations

Unintended consequences rears its ugly head again:

Doctors sometimes order a diagnostic test that doesn’t need preauthorization “” even if it provides less-helpful information than the one they prefer “” then seek approval for a more advanced test if the first one shows it’s needed.

Worse yet, sometimes patients end up getting a riskier, more invasive test than what they really need, said Hendel. For example, cardiologists wanting to assess blood flow and blockages inside a patient’s heart arteries would prefer a nuclear cardiology test. With that, a small amount of a radioactive substance is injected in the blood and tracked using a camera.

Some doctors will instead order a cardiac catheterization, which doesn’t require advance authorization . . .and carries a 10-times higher risk of complications such as a heart attack or stroke.