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A Prior Authorization Hack

Daniel Paull MD suggests something the doctor can do, while a cumbersome peer to peer is being scheduled by your insurance company.

January 2, 2024

Pro tip when it comes to prior authorization:

If you are contracted with health insurance companies (which most are), then you are contractually obligated to do peer to peers to get things approved for your patients, like medications and imaging.

But what you can do, while the peer to peer is being scheduled, is to call the patient and let them know that their heartless insurance company wants to deny the medication/imaging/treatment that you ordered.

 

A gif of a man (Ryan Goslin, we think), wagging his finger, as in
… real bad (yes, this is Ryan Goslin)..

 

You then encourage the patient to call the insurance company and complain, or threaten to complain to the state.

 

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Sometimes this is enough to get the study approved, before you even get to the peer to peer.

This will save you time and frustration while likely not violating your contract.

More importantly it lets your patients know the misaligned interests of their health insurance company, and makes them take an active part in their care.

It is abominable that health insurance companies can get away with denying necessary care in most cases.

It also raises the question of how they even determine this when they have not even examine the patient!

 

It is abominable that health insurance companies can get away with denying necessary care in most cases. Share on X

 

That is what we call bad medicine.

I would not want a non-physician whom I’ve never met making medical decisions that run counter to my physician who is treating me.

It’s yet another reason why I don’t work with them!

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. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

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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