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It’s On THEM

Daniel Paull MD explains why he refuses to do prior authorizations.

I just got asked to do a prior authorization for an MRI, which is rare for me because I don’t take insurances and deal mostly with patients who pay cash.

Sometimes my cash paying patients want to use their insurance for other services, which of course is fine, as they pay high premiums and want to extract some value out of their policy.

The problem occurs when the insurance company starts requiring hoop jumping, which I fundamentally refuse to do.

If the insurance company doesn’t want to approve an MRI that I think is reasonable and necessary, then it is on them, and not on me.

The prior authorization is meant to generate attrition by asking an already busy physician to spend unpaid time navigating phone trees, hang-ups, and transfers until they get what they need.

 

The prior authorization is meant to generate attrition by asking an already busy physician to spend unpaid time navigating phone trees, hang-ups, and transfers until they get what they need. Click To Tweet

 

When I told the prior authorization lady that I don’t believe in prior authorizations, there was a long pause.

She didn’t know what to say, probably because no one had ever said that to her.

I told her that the denial is on the insurance company, not on me.

The greater irony is that a cash pay MRI is normally much less for those who have insurance and have a high deductible. They will stop playing games when we refuse to play.

This is what real change looks like.

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