What are prior authorizations really?
The health insurance companies would tell you that they are necessary to make sure that the patient isn’t getting any “unnecessary care”.
How do they make these decisions?
They look at your chart, and apply an algorithm (probably uses AI at this point), and then make the decision.
Example: Patient with bone on bone knee arthritis see’s a joint surgeon who recommends a knee replacement. The health insurance company denies it, stating that physical therapy has not been tried and failed first.
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Maybe that sounds good, unless you are the patient with excruciating pain from bone on bone arthritis who can’t tolerate even a single PT session.
The question is who would you rather trust your care to:
A health insurance company who is financially incentivized to deny care based off of a barely readable clinic note and a computer algorithm
OR
You doctor who HAS ACTUALLY SEEN AND EXAMINED YOU, and mostly always wants you to get better.
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The bottom line is that health insurance companies could not care less if you suffer or experience bad outcomes.
They get to keep money by not paying for your care and have absolutely zero liability.
Your physician wants you to get better and has liability if things go wrong.
