Lancaster Physician Fall 2017 - 22

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Patient Advocacy

INSURANCE
PRIOR
AUTH
DELAYS
HARM
PATIENTS
Doctors Must Be Part of the Solution
JEFF WIRICK,

Pennsylvania Medical Society

I

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.

When his current allotment of pain medicine
ran out, the withdrawal symptoms began.

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.

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.

LANCASTER

22

PHYSICIAN

"Cold sweats. Shaking. You don't have
control," Stanziano described.
This wasn't a one-time mistake by his
insurance company.



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