Tuesday, November 10, 2015

Who oversees medication pre-authorization?

Have you ever tried to get a medication preauthorized for your patient, only to be told "no" the insurance company won't pay for your patient to have the medication you say they need?  I've been trying to get a medication authorized, and I decided to see this through.  In some cases it seems there is no end to the hoops the insurance company can set, and no time frame for when they must answer.  Read my account here on the Clinical Psychiatry News website. 


Joel Hassman, MD said...

This is it, this is what drags them into accountability and responsibility for malpractice, both neglect and malfeasance. Just document all this on paper; calls and computer forms ain't going to make it into a court room!

Unfortunately, you have to see patients fall, and hard. But, it is their insurance, and if they can't or won't advocate for themselves, well, the defendants' lawyers can and will use that against the patients.

No pain, no gain. Yeah, harsh and abrupt. So are those authorization claims!!!

moviedoc said...

What they payer reimburses is between the payer and the subscriber. Physicians should supply the information (with the patient's authorization, of course) and otherwise stay out. When you start trying to get $$$ for patients, it raises ethical questions. What about that terrible deductible? Does that make you mad? Remember, the more the payer reimburses, the higher the premiums go.

Data DrivenFP said...

The problem is, you didn't know you were in an abusive relationship.
They make the rules.
They control the money
You have to follow the rules.
If you don't follow the rules you get punished.
If they don't follow the rules nothing happens
They can change the rules...

But all the FFS involves abuse.

There's a discussion going on about Alternate Payment Methods for Medicare and measuring quality over at-.https://handshake.mitre.org/blog/view/15007118/why-the-white-paper-schemes-are-doomed-to-fail-how-they-could-succeed
but you have to email Kris prendergast to get accesss to MITRE "Prendergast, Kris"

see the draft and initial comments here:


about life said...

Have you considered having your patient order the medication from India. I know it sounds crazy, but Canada gets its supply of modinafil from an India company, and your patient would be able to get the medication for $2 a pill.

I was skeptical at first also but modinafil is a greatly used drug here in the states by college students and businessmen and many websites have been set up to make the purchase easy. I have used modinafilcat.com for one of my patients with treatment resistant depression and had very good results.