Ben Brewer (via the WSJ Health Blog) talks about how insurance pre-authorizations leads to many doctors just giving up, in effect surrendering to the whims of insurance companies:
They want me to incur the overhead and frustration that comes with trying to prove to a non-doctor that I know my patient and what I’m talking about. They want to cut costs, and they don’t really care about how it affects my patients or my practice. If they make the process hard enough, they hope I’ll just give up. There is even a term in the managed care literature for that kind of deterrence: the “sentinel effect.”
Medicare is starting to use some of these insurance tactics, such as considering a pre-authorization program for imaging studies.
Dr. Brewer notes that many patients are not aware of the daily battles that physician fight for on their behalf.
Some doctors I know share the paperwork burden with patients, having them fill out pre-authorization forms to the best of their ability, and having patients call the insurance companies themselves if medications or procedures are denied.
Although that’s somewhat of a draconian tactic, it does accomplish the goal of getting patients to share our outrage against a common adversary.
Like allying with the AARP against Medicare payment cuts, the only way for physicians to affect change is to have patients backing us up.
Related posts:
- Prior authorizations for Medicare?
- Getting around pre-authorizations
- Medicare now requires physician essays for hospice care, as if pre-authorizations weren’t bad enough
- Can radiology pre-authorizations lead to turf wars?
- The physician-patient relationship: "An endangered species"
- More PCPs shun the zoster vaccine
- When primary care refuses to accept Medicare
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This is a complex issue because there are insurance companies creating all of these administrative hoops that physicians need to jump through, while at the same time physicians are practicing defensive medicine. You can’t effectively address the one issue without addressing the other. It just shows why we need to get all players to the table to create a comprehensive solution that addresses the underlying problems, causing all of the associated symptoms to go away. No one ever said it would be easy!
When insurance companies hassle me like this, I just tell the patient that they have bad insurance, and send them to an ER or to a specialist whose income better offsets the the administrative costs of pre-authorizations. The insurance companies wind up paying lots more — not less.
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