Urology Times reached out to three urologists (selected randomly) and asked them each the following question: What’s your biggest frustration with prior authorization?
"One is the delay in delivering care. If I order surgery that requires prior authorization, it won’t always come through in a timely manner, and that impacts patients’ quality of life.
The second is the wear and tear on my nursing staff navigating the prior authorization process. It’s relatively thankless work, so it doesn’t enhance my team’s satisfaction.
Also from Karen Nash: What are you doing to safeguard patient information?
Even minor issues, like having a procedure approved as an inpatient procedure, and if we do it outpatient (same hospital, same operating room, same staff), the insurance company can deny payment. Our hospital lost about $2.7 million one year because the status of admission was incorrect. The care is delivered, but they declined payment because the right box wasn’t checked.
We also get denials and have to appeal things that shouldn’t be necessary. For example, for a patient with relatively severe Parkinson’s disease with urge incontinence, the insurance company wants me to prescribe an anticholinergic, which unfortunately significantly impacts the severity of Parkinson’s. Insurance will deny medication that won’t impact Parkinson’s, and it has to be appealed. Even then, it will cost more out of pocket or the patient won’t get the medication, more commonly the latter.
The denial is not a denial because ‘we don’t think your medical decision was correct’; the denial is because ‘this medication is our preferred medication.’ ”
Christopher Boelter, MD / Sartell, MN