MCMS Physician Fall 2017 - 18
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Insurance Prior Auth Delays Harm Patients -
Doctors Must Be Part of the Solution!
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"What if I would have died with this?" he said. "Personally, I'm
just irritated that the insurance companies have so much power
over doctors trying to get their patients what they need."
Pittsburgh's Kristen O'Toole experienced delays in getting
an MRI for her back pain. The weeks' long wait allowed her
undiagnosed multiple sclerosis to progress, and she is now in a
"If I had gotten the MRI earlier and started on the infusions,
I really believe it could have kept some of these symptoms at
bay," O'Toole said. "Maybe I would have never ended up in a
"The doctor knows there's a problem here," O'Toole added.
"There's something going on. And how is he going to know before
he gets the data from the MRI?"
Dr. Skubick said his biggest frustration with the rise of prior
authorizations is that it takes the clinical decision-making out of
the hands of physicians.
"I think it is incredible that the insurance company would
think that a person who has practiced neurology for 35, 40 years
doesn't know more than somebody on the other end without
seeing the patient," he said. "I've never had a pre-cert denied for
any diagnostic study when I'm able to talk to a colleague that is a
"But I'm talking to people (at the insurance companies) who
are not even doctors some of the time. And sometimes when you
do get a doctor, you're getting an internist or a gynecologist - what
do they know about neurology? What do they know about the
subtleties about whether an MRI is necessary?"
Physicians Must Be Part
of the Solution
Oncologist Rick Boulay, MD, wrote a recent blog for
KevinMD: "Most patients are unaware of this, but your physician
is likely your biggest advocate when it comes to getting your care
covered" from prior auth.
Similarly, physicians need to step up to support new legislation
in Pennsylvania that aims to decrease patient wait times from prior
House Bill 1293, introduced by Rep. Marguerite Quinn
* Increase transparency and consistency in prior authorization
* Establish standards for and reduce the overuse of prior
* Lessen manual processes and enhance the electronic exchange
* Develop a standard prior authorization form.
The Pennsylvania Medical Society and its coalition of 50+
physician and patient advocacy organizations support HB 1293.
But this legislation will only move with a strong grassroots effort
from physicians, medical office personnel, and patients.
See how you can get involved by going to the PAMED website,
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Table of Contents for the Digital Edition of MCMS Physician Fall 2017
MCMS Physician Fall 2017 - 1
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