LCHM Winter18 - 24
Doctors Must Be Part of the Solution!
BY JEFF WIRICK, PENNSYLVANIA MEDICAL SOCIETY
nsurance companies say they use prior authorization to prevent
physicians from prescribing too much medication or ordering too
many tests. But physicians say the use of prior auth has grown out of
control - and few stories illustrate it better than that of Joe Stanziano.
Stanziano, who currently resides in Montgomery County
(Pa.), owned a bakery in New Jersey. Ten years of carrying heavy
bags of flour and working 18-hour days took a toll on his back.
Stanziano had just undergone his fourth back surgery in five years
and was taking pain medication to help with his recovery. Things were
progressing well enough for Stanziano to begin taking a smaller dose of
the pain medication - a process known as tapering that could eventually
allow him to wean off the medication altogether.
The problem is, Stanziano's insurance company denied payment of
the lower dosage that his neurologist prescribed. Hours turned into days
and Stanziano continued to wait for his insurance company's approval.
When his current allotment of pain medicine ran out, the withdrawal
"Cold sweats. Shaking. You don't have control," Stanziano described.
This wasn't a one-time mistake by his insurance company.
Stanziano's neurologist prescribed a lower dose of pain medication five
times. It was denied five times for up to a week before it was approved.
As the delays grew longer and withdrawals continued, Stanziano
opted to buy the medication out of his own pocket. Each pill cost $60.
24 Lehigh County Health & Medicine | WINTER 2018