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

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

May 12, 2023

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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All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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15 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.

        1. Linda I’m in the same boat except my doctor won’t be honest with me about not filling out the pa. I’ve called several times and been told it was getting done but they never provided proof. This should be a lawsuit against the doctor! I paid them to prescribe the medication in the first place. It’s on them for refusing to follow through. If every doctor refuses to send my prescriptions to the right pharmacy and refuses to fill out a PA or switch prescriptions am I supposed to just die? They should be held responsible for this. Not the insurance company.

          1. The Doctors rarely are the ones completing the prior authorization
            ( unless a peer to peer call needs to happen) it is their staff, medical assistants, nurses…

          2. Not very smart
            I would never pay for something like this! Do it yourself so that you know it
            Gets done!

  1. I pay a lot for my health insurance. Prior auths are just part of the game. Please file complaints against any doctor who does this. I wouldn’t trust this doctor with my life at all. He sounds like a heartless AH. Clearly doesn’t value the health and well-being of his patients. He could fight the system without risking harm to the people he is supposed to be treating.

  2. I have just learned that my current PCP’s office is no longer submitting PAs because of the time involved, plus they get 100s of them. The medication I need to go on is covered by my insurance but requires a PA because it is one of the newly approved obesity drugs. I am so sick of insurance companies and health care institutions. I have to pay a $150 copay for follow up with my oncologist bc the medical center I go to considers any visit to the Cancer center as a hospital visit. So for a 15 min follow up every 6 months I pay a $150 CO pay when my co pay to see a specialist is only $40. It is all BS

  3. My hats off to you sir! With the increased demand for prior authoritarian for GLP-1 ‘s and other blood sugar and weight loss medications, I am now spending thousands of dollars a month on personnel to push through these prior authorizations. I’m a struggling private practice. Sometimes I don’t take home a paycheck. I resent having to pay someone to force the insurance company to pay for what the patient needs.
    Medicare of course does not allow us to bull for that service to the patient. The more the insurance companies have us do for free is the more their CEO’s make.

  4. I can see how frustrating it must be for the patient who is basically at the mercy of not only the insurance company but also the doctor who provides the care. I certainly see the providers side of it because I am married to one and I am the one who has to process the prior authorizations when the insurance companies require them! Patients constantly calling in, emails, voicemails, texts messages! The pharmacy sending faxes and leaving messages that someone has to respond to which takes time, uncompensated time! That is why my wife is considering discontinuing the prior authorizations as well! We are a small clinic and do not have the personnel to continue doing it. It’s really not a matter of choice, we simply can’t spend hours a day. And it’s frustrating that the patient suffers because the insurance companies refuse to pay if the doctor doesn’t jump through their hoops

  5. As someone who has had to argue with insurance companies to get prior authorizations done u do know the doctors office holds weight when talking to these companies. I just hope when patients leave your office they feel that they have received the best level of care because from reading this article I can’t tell u DONT give it

  6. If a doctor refuses to do a required prior authorization for me, then they are fired on the spot. They work for me. I pay their salary, and I will terminate them from my employment if they do not perform up to my expectations!

  7. Physicians are aware prior to certain medications prescribed or other services that private insurance companies require a PA. The physicians that are denying to sign a PA should be held accountable and brought in front of the medical board.

  8. I am not a physician nor any type of health care provider. but I completely agree with your position on pre-authorizations. The time and efforts necessary to go through this process are better spent on healing. Persons of your profession (or any other), should not be made to jump through hoops to provide effective treatment. I can’t believe that insurance companies need to tighten their belts to be profitable. It appears that they are greedy!

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