Insurance companies are increasing relying on pre-authorizations to limit imaging studies, which dramatically raises health care costs.
The process claims to be in “real-time”, but in many cases, there a delay that a busy primary care physician can ill-afford. Even waiting 10 minutes to speak with a radiologist pushes the schedule back a whole appointment.
One of the major causes for ill-advised studies is the direct marketing to patients:
Increasingly, high-technology screening tests are being marketed directly to consumers through print, electronic and broadcast media. Many consumers who are willing to pay out-of-pocket for these tests can do so without a physician referral. Others are going to their physicians and requesting that they refer them for these screenings. Yet, some of the technologies being marketed are not recommended for the general population, particularly the low-risk population because of a lack of proven benefits. Additionally, screening of asymptomatic individuals carries the risk of false-positive test results that can lead to extensive or invasive follow-up examinations.
Removing these advertisements for inappropriate scans can reduce the demand for unnecessary testing.
Pre-authorization is simply a bureaucratic hurdle masked in the guise of “physician education”. Besides, if a doctor really wanted a scan done, sending the patient to the emergency room provides an easy workaround to this obstacle.
