Post-it Sunday 8/4/24-Prior authorization is not a good thing for patients

The post-it reads “Prior authorization has negative impact for patients.”

Yeah, I got this from one of the OR newsletters I read.

And also, no shit, Sherlock!

Prior authorization is when you have to go before the insurance board, the insurance that you pay for, and ask for a test, physical therapy, imaging studies, surgery for your appendix, and what have you, you have to seek permission. You have to seek permission for the care that you need.

It’s like we are all back in grade school, asking the mean old nun for a pass to go to the bathroom. The kicker is that, just like then, what you seek, and what you really, really need, can be denied at their whim.

This is from an article about a physician survey that illustrates how negative the impact can be of prior authorization.

The biggest no-duh is that necessary care is delayed, as relayed by 940/1000 survey respondents.

19% cited serious adverse events suffered by patients because of denial of prior authorization.

Serious adverse events leading to life-threatening events and needed intervention to prevent permanent impairment happened 13% of the time, according to these doctors.

Even more serious adverse events, including disability, permanent harm, birth defects, and DEATH happened 7% of the time due to denial of prior authorization.

Yeah, I like it when my insurance company is not actively seeking to kill me.

Often with no explanation; just to save a buck.

This has to do with the allocation of resources, I get it. I understand that not everyone can be saved.

But, the article goes on to say that it is not other peer-to-peer medical type people making these seemingly off-the-cuff decisions.

Seeking prior authorization, often more than once, and not being able to have a doctor to doctor conversation where they speak the same language? How much does that cost the medical practice?

Sounds like being penny wise and pound foolish.

Has prior authorization outgrown its banks?

Absolutely!

I’m open to suggestions about how to fix the dumpster fire.

Or do we continue to let it burn? And continue to hurt, disable, and kill patients?

Where is that lawsuit?

Oops, I said the L word.