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I’m A Doctor and I Refuse to Do Prior Authorizations

I’m A Doctor and I Refuse to Do Prior Authorizations

[Daniel Paull MD, on why he "doesn't do" prior authorizations.]

Something that many physicians do, that I refuse to do: prior authorizations.

I won’t do them.

You might be asking, “Well what if the patient needs an MRI, and it requires a prior authorization”.

I still won’t do it.

If I get wind that a patient of mine is possibly going to get denied for an MRI, I call the patient up, and let them know that the insurance company doesn’t want to pay for it. I put the blame squarely on the insurance company, and let the patient know that they should call them to complain.

 

“I put the blame squarely on the insurance company, and let the patient know that they should call them to complain.”

 

The insurance company is the one that refuses to get them the MRI, not me.

As to how they can deny necessary medical imaging by the medical expert that saw them is beyond me.

Sometimes patients complaining will get the study approved.

 

Sometimes patients complaining (to the insurance company, when a study ordered by the doctor was denied) will get the study approved. Click To Tweet

 

If not, the patient always has the option to pay cash for an MRI, which is sometimes less than what they would have paid with insurance.

If the insurance denies what I deem necessary as a medical expert (orthopedic surgeon), then that is on them, it’s not on me.

The longer we keep doing prior authorizations, the longer they will exist.

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3 Responses

    1. No sir, he is not a piece of shit… the insurance companies are the pieces of shit. He is right, if medical providers stopped filling them out the insurance companies would have to stop them. There is already WAY too much nonsensical paperwork medical providers have to deal with that takes time away from the patient. If the medical provider orders the medication or procedure and had discussed with the patient the insurance company should pay for it… that is how it should work.

      1. It’s great to take a stand. But in the real world, there are critical medications that insurance companies are denying. My son takes one. He has to take a specific medication that our prior insurance approved without question, but our new insurance requires a PA. Is he supposed to stop taking the medication… and die? Am I supposed to pay $950 out of pocket every month, which I can’t afford? The reason why I wound up at this page was because his doctor refused to complete the PA. I am at a loss. Now I have to hope I can get an appointment with another specialist before this prescription runs out, take another day off from work, pull my kid out of school, and start a relationship with another medical practice so my kid doesn’t land in the hospital. Doctors are supposed to “do no harm.” This is BS.

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