OK so today I opened a piece of mail that looked fake AF. It was from national government services and I actually thought it was just a solicitation about a Medicare advantage plan.

It looks like it’s approving the Botox so maybe they will get paid now. I’m not sure why they had to do this twice, the way that letter reads makes it sound like now these procedures need prior authorization so maybe they didn’t before but by the time they submitted the charge they did?

I don’t know, they will handle it, I’m just relieved the hospital isn’t stuck with a $10,000 bill because of me.

#medicare #priorauthorization

Today's #PriorAuthorization rage: I'm trying to get a continuous glucose monitor for a diabetic patient. I prescribed the one her insurance prefers -- but prior auth is needed. Pt told me she was denied, because I didn't provide info. As near as I can tell, my office never got a request for info. So today I call to give the information. After 10+ minutes of prelim, rep tells me I CAN'T give info over phone. They need to fax me a form. I'm not at office. Sorry, it's got to be a fax.

The new bills would make enacting reforms to #PriorAuthorization more difficult by discouraging government mandates on #HealthInsurance [plans]. #NorthCarolina #Legislature https://buff.ly/4gHfFyp

In 2023, there were nearly 2 #PriorAuthorization determinations on average per #MedicareAdvantage enrollee, similar to the amount in 2019. #Medicare https://buff.ly/40ARHz8

Now this just might work! A UHC #shareholder group proposed an analysis of how #PriorAuthorization and #denials of medical services lead patients to forgo treatment. #UnitedHealthcare #Healthcare #MedicalCosts #HealthInsurance https://buff.ly/4fSRwEI

Insurance is demanding prior auth for Trulicity. Kinda shows this is going through an automated system since a doctor reviewing this would see it’s justified.

For me, it’s just more delays getting access to a drug I actually need.

We are still not even to the part where we learn if they can even send the drug.

#Diabetes #T2D #Trulicity #GLP1RA #PriorAuthorization #InsuranceIsAScam #Shortage

#PriorAuthorization buries doctors in paperwork and delays care, sometimes with disastrous results. https://apple.news/AFhUBujTIRH6OK6jteWFUGA

Today I wrote this in a clinical note (yes in all caps):

"IN CASE AN INSURER IS READING THIS DOCUMENT, PLEASE CONTACT DR. MCKINNEY TO DISCUSS THE PATIENT'S CHRONIC MEDICAL CONDITION AND HOW TREATING IT CORRECTLY (RATHER THAN DENYING CARE) WILL SAVE YOU MONEY."

That's screaming into the ether because I can't seem to navigate #PriorAuthorization processes despite many very long phone calls and attempts. Yay.

I went to medical school to treat cancer, blast kidney stones, and help patients enjoy their sex lives.

You went to medical school to help insurance companies deny patients life-saving care.

We are not the same.

“Peer to peer“ my ass.

#PriorAuthorization #PeerToPeer

This @washingtonpost article about #PriorAuthorization battles really hit home. Living with #Type1Diabetes, I’ve dealt with this way too often. But that $21.6 billion in lost productivity incurred by those of us living with chronic medical conditions is sickening. I loathe to think of how much of my life I’ve lost not to my disease, but to time I’ve spent dealing with insurance and administrative crap. https://www.washingtonpost.com/wellness/2023/01/30/high-priced-drugs-step-insurance-policies/

Breaking down the pain of prior authorizations: a physician's perspective

As a physician, I've had the opportunity to delve into the world of medical management, including the much-dreaded process of prior authorizations. While it may be a thorn in the side of many of my colleagues, my experience has given me a unique perspective on the subject.

Gary Call is a family physician and health care executive.

https://youtube.com/shorts/qbEXJbdYtao

Listen here: https://kevinmd.com/podcast

#PriorAuthorization

"Authorizations, provider eligibility and code inaccuracies were among the health system officials said #HealthInsurance #Claims are denied, according to a recent report." #Denial #PriorAuthorization #Networks https://www.beckershospitalreview.com/finance/13-top-reasons-for-claims-denials.html

"The agency proposed in a rule last year to mandate plans in government programs adopt electronic #PriorAuthorization systems by 2026." #HealthInsurance #ManagedCare #CMS https://www.fiercehealthcare.com/providers/providers-press-cms-finalize-prior-authorization-reforms-alleviate-major-administrative

All a Prior Authorization is, is an insurance filibuster to delay care until the patient:

1. Resigns to suboptimal alternatives that are often based on formulary and behind closed doors handshake / handjob kickback agreements

2. Quits trying

3. Dies

#PriorAuthorization #MedMastodon
#Capitalism