Lancaster Physician Fall 2017 - 24

Patient Advocacy

A LOCAL
PERSPECTIVE

Regional Gi and
MidAtlantic Endoscopy

JAMES M KELLY, MD

proudly welcome

LGHP - Lincoln Family Medicine, Ephrata PA

Lisa J. Yoo, DO

I

am ecstatic and relieved that PAMED is tackling reform of the prior authorization process.
A significant portion of my workweek now
includes contacting insurance companies to seek
authorization for patient testing or medication. This
process has become more frequent and cumbersome
each year of my career. Repetitive authorizations for
the same service, being placed on hold for 30-45
minutes, and denial of payment (even after an authorization) have become commonplace. The increase
in administrative burden from authorizations has
unfortunately decreased time physicians are available
for direct patient care, thus limiting patients' access
to appointment times with their physician.
Many prior authorizations are unnecessary hoops
whereby insurance companies hinder appropriate
quality care in the name of trying to control cost of
care. A few recent examples from my practice include:
A diabetic patient's change in insurance resulted
in the need for authorization of a medication he
had been taking successfully to control his blood
sugar for approximately 3 years.

Dr. Lisa Yoo, a graduate of Manheim Township High
School and Franklin & Marshall College, is excited to
live in her hometown of Lancaster and establish her
practice of medicine.



She earned her medical degree at Lake Erie College of
Osteopathic Medicine and completed her Residency
and Fellowship in Gastroenterology at Hershey
Medical Center. Dr. Yoo also graduated from a postbaccalaureate program in Interdisciplinary Medical
Science at Drexel College of Medicine.



Dr. Yoo, who is fluent in Korean, enjoys scuba diving
and is a second degree black belt in Tang Soo Do.
Call 717-283-4792 to schedule an appointment.

Regional Gi

MidAtlantic Endoscopy

2112 Harrisburg Pike
Suite 202
Lancaster, PA
17601

2112 Harrisburg Pike
Suite 323
Lancaster, PA
17601

regionalgi.com

midatlanticendoscopycenter.com
2104 Harrisburg Pike
Suite 300
Lancaster, PA
17601

4140 Oregon Pike
Ephrata, PA
17522

LANCASTER

24

A CT scan was denied for a 36-year-old patient
with enlarged neck lymph nodes and a lung mass
detected on a chest xray.
A continuous glucose monitor was denied for
a 21-year-old college student with documented
problems with low blood sugars. In this case, the
reason for denial was that the patient had not had
a severe episode of low blood sugar causing her to
become unconscious or have a seizure.


In each of these cases, my nurses contacted the
insurance companies, and I either wrote letters
or personally spoke to physicians at the insurance
companies to obtain approval for the needed care.
Insurance formularies that change yearly, variable
authorization processes, and lack of standards as
to what deserves authorization are drivers of the
problem. I look forward to and will certainly be an
advocate for PAMED as they pursue and hopefully
solve this problem for Pennsylvania physicians.

PHYSICIAN


http://www.regionalgi.com http://www.midatlanticendoscopycenter.com

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