fbpx

Who Really Pays the Price with Prior Authorization?

Daniel Paull MD tells of how prior authorization caused a patient to lose her leg.

December 21, 2023

Let’s say that you’re having a lot of hip pain.

It bothers you during the day, but it really hurts at night.

It also has felt like you’ve been sick for the past six months, as you’ve had a general malaise.

“I must be eating less”. This helps explain the 20 pounds you lost over the past few months without trying.

 

Since your hip bothers you, and it isn’t getting any better, your PCP refers you to some physical therapy, and it doesn’t work.

Eventually you get referred to an orthopedic surgeon, who seems somewhat alarmed.

They want an MRI immediately.

This scares you.

 

 

Nervously waiting your MRI, you find out that that your health insurance company denies it, saying that they want you to do physical therapy first, which you already did.

Your doctor has to appeal the MRI, and 41 days later, you finally get it approved.

 

To your horror, the MRI reveals an aggressive bone tumor, and you will need to get half of your pelvis and the rest of your leg amputated.

 

To your horror, the MRI reveals an aggressive bone tumor, and you will need to get half of your pelvis and the rest of your leg amputated. Read a true story of prior auth denial. Share on X

 

The doctors say that if you had come in a month earlier then they could have probably just done chemo.

Unfortunately for you and your family, the cancer continues to spread, and this is how you die.

 

Health insurers routinely deny necessary care and have absolutely no legal liability.

A cash pay MRI can cost $500, which is sometimes less than those with a high deductible will pay.

Health insurance is a huge scam with real life sometimes dire consequences.

The above story is a real story.

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.

Share

Leave a Reply

Your email address will not be published. Required fields are marked *

This learning experience is powered by CMEfy - a platform that brings relevant CMEs to busy clinicians, at the right place and right time. Using short learning nudges, clinicians can reflect and unlock AMA PRA Category 1 Credit.

Of Interest

Subscribe To Our Newsletter

Get updates and learn from the best

Dana Corriel, MD

Speaker: Dana Corriel, MD

Dr. Dana Corriel is a physician entrepreneur who has built her own digital startup from the ground up and has grown physician communities. She can lecture on most topics, where it comes to the healthcare digital space.

Side Ventures [SERIES]

Side Ventures [SERIES]

Coming Soon: Guests will discuss the side ventures they’ve taken on, from the books they’re writing, to the podcasts they host, to other extracurriculars they’ve taken on.

Kimberly Parks, DO

Kimberly Parks, DO

I am a physician health care entrepreneur disrupting conventional medical care through integrative well care.

Want More?

Be a part of our healthcare revolution. Don't miss a thing SoMeDocs publishes!

Disclaimer: SoMeDocs assumes no responsibility for the accuracy, claims, or content of the individual experts' profiles, contributions and courses. Details within posts cannot be verified. This site does not represent medical advice and you should always consult with your private physician before taking on anything you read online. See SoMeDocs' Terms of Use for more information.

follow us

© 2024 SoMeDocs. All Rights Reserved.

Soak up content & grow

Educational reflections..

Drop your email address below and we’ll email you the link for continuing opportunity pathways from CMEfy. Check your spam folder if you do not receive our email. We’ll also add you to our Sunday newsletter, so you can receive even more of our unique content!

Support A Platform that Celebrates Real Doctors

For just $10 a month, you can help keep this openly accessible site available to all & help us sponsor in more doctors.

Interested in subscribing
to our unique content?

Interested in subscribing to our unique content?

Play Video
Our Founder Answers Your BURNING Question

SoMeDocs

“Why should I become a member of SoMeDocs if I already have my own space online?”

Site SoMeDocs Logo, square

WANT TO STAY IN THE LOOP?

DON'T MISS A SINGLE CONTENT PIECE.