Central PA Medicine - Summer 2017 - 5

daup h i n c m s .o rg

necessary. The bright side is that patients are
much less likely to get a large bill for something
not approved, and the providers know ahead
of time what the insurance company is likely
to pay. But there is a dark side. It adds a layer
of cost, hassle, and frustration to the ordering
physician. Surprisingly, pre-authorization does
not even guarantee any payment will be made.
The insurance company still retains the right to
not pay for the service! As the pre-authorization
process takes over every nook and cranny of
medicine, an army of billing specialists have
been employed to shepherd providers, and
physicians are spending more and more and
more time devoted to filling out forms, waiting
on hold to talk to a reviewer, and then talking
to reviewers about why they want to a patient
to have a certain drug or procedure. The vast
majority of preauthorizations are approved, largely
because physicians are fairly good at prescribing
appropriate interventions. So, in most cases, it is
a waste of effort that adds value to no one. Even

in cases where the prescription is not approved,
it is rarely because the recommendation of the
physician was wrong. It is almost always because
there was another cheaper alternative the insurance
company demands must be done first, irregardless
of whether or not that makes the most sense for
that individual patient.
PAMED is not sitting idly by while this
carries on. PAMED supports HB 12931, a bill
introduced 4/26/2017 that streamlines the prior
authorization process with insurance plans. This
will codify limits on what obstacles insurance
companies can put in place for the approval of
medical prescriptions and orders. Even if there
are unintended consequences, and almost all
legislation does, for most of us in the house of
medicine, it will provide some much-needed relief
if passed. It is not a given this will pass as it will
likely be opposed by the insurance companies, but
if physicians and patients call their legislators, it
will, as this issue has enormous bipartisan support.

However, this issue shouldn't be about demonizing insurance companies. I voluntarily
remain in the world of health insurance, and
so will most of you. Furthermore, PAMED
represents all physicians, including those working
for the insurance industry as policy makers and
reviewers. Most of them truly want patients to
get appropriate cost-effective care, and they are
frustrated by the process as well. By working
together and advocating for our patients, we can
make this mess better. So stay engaged!
Dr. Mackley is a Radiation Oncologist at the
Penn State Cancer Institute and Professor of Radiology, Medicine, and Pediatrics in the Penn
State College of Medicine. As the 5th District
Trustee on the PAMED Board, he represents
physicians of this county.

Endnotes

1 https://www.pamedsoc.org/Pages/
Advocate%20Specific/PAMED-Priorities.
aspx

Straight Talk about Treating Vein Problems--A Question and Answer Session
with noted surgeon Dr. John Mathai, M.D., F.A.C.S., F.A.C.C. and director of
Premier Vein Specialists (offices in Camp Hill, Hanover and York)
Q: My legs look veiny and I don't like it. How do I pick a doctor?
A: Look for an experienced surgeon and a practice where you feel comfortable. I practiced heart surgery for over
three decades before specializing in the treatment of veins. I am double Board Certified with The American Board of
Surgery and the American Board of Thoracic Surgery, and a Member of the American College of Phlebology. Our
staff is friendly and we like to think it is a welcoming environment. One of the reasons we offer a free evaluation
screening appointment for spider veins is so that you get a chance to see what your situation is and see how you like
it here at no risk.
Q: Is vein surgery expensive?
A: Most of the procedures we conduct are covered by typical medical insurance programs.
Q: Are the procedures painful?
A: All procedures are done with local anesthetic, with the patient awake. Discomfort is minimal.
Q: What is the typical recovery time?
A: The procedures are done in our offices and the patient walks in and walks out. Most patients return to work the
next day.
Q: Are vein problems purely cosmetic?
A: No. Most are medical conditions. With insurance covering most procedures, there is no reason to endure leg pain
or not like the way your legs look.

Central PA Medicine Summer 2017 5

http://www.dauphincms.org https://www.pamedsoc.org/Pages/ http://www.premierveinpa.com

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