Change Your Life: Plan Your Illness in Advance - Prepare With Pre-Authorization Frustration

Friday, December 24, 2010

Plan Your Illness in Advance - Prepare With Pre-Authorization Frustration

Plan Your Illness in Advance - Prepare With Pre-Authorization Frustration | Psychology Today

True Grit is better than any film nominated for the Golden Globe Awards.

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It's the demand for compulsory perfection at Christmas that's not natural.

Kate Distin, Ph.D.

The health insurance industry has labored to obstruct sensible use of medical services.

Matthew Edlund, M.D. Mark D. White PhD

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Recently Diagnosed?Diagnosis Dictionary Magazine Tests Psych Basics Experts Blogs The Power of Rest Why sleep alone is not enough–and how to reset your body. by Matthew Edlund, M.D. Plan Your Illness in Advance - Prepare With Pre-Authorization Frustration Thinking of getting sick? Prevention may prove your only cure. Published on December 23, 2010

Health Insurance Helps Insure You Won't Be Insured

Do you really think you have health coverage? Over decades the health insurance industry has labored to perfect methods that obstruct sensible use of medical services. Their abilities continue to improve. We should expect worsening care, higher prices, and a poorly served, frustrated population - including you.
Here's one very, very small but instructive example of how insurance obstruction works - the preauthorization "process."

My quest was to get a higher dose of a rather cheap generic antidepressant for a woman who'd been on the medication for years. Her diagnostic list was long, including sleep apnea, lupus, hypoadrenalism, and diabetes. In this case I was trying to persuade representatives from one of the many Blue Cross Blue Shield insurers, though my experiences with other insurers has been similar.
The pharmacy sent me a fax declaring I would need to get preauthorization through the health insurance company. The form included the listings of the patient's insurance card number and group. Here's how it went:

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I call a 1-888 number. A stalwart voice answers - the number has been changed. I must call a 1-900 number, and I will be charged $1.99 a minute.
Is Blue Cross really going to charge me two bucks a minute because I'm trying to get my patient a bit more of a generic drug?
I examine the form again with my office manager. In very small print there's another number we can call - an 1-800 number.
I call through. This one really does reach Blue Cross Blue Shield. After a wait, I'm switched through to voice mail which gives me several options for bill paying and checking charges. None of them have the specific option I'm calling for - so I hit the final option, "other."
I'm rerouted to the same message. I carefully listen to the options, hoping there's something that will give me a chance to get through to a person.
I'm disconnected. (That happens all the time.)

Keep Dialing

I call again. This time there's another option available for "doctors and doctor representatives." I pound the proper tones on the phone and get - the demand to call another number.
I call this new 1- 800 number. This time I'm requested to punch in the "ID" number of the patient without its first letter prefix. I have two insurance identifiers, but the only one with a prefix is for a group. I try it. I wait.
More numbers are requested, including my "NPI" number. I punch those in and - The phone is dialing something else. I listen to ads about the fine medical coverages available plus the option to take "just 30 seconds" to review my call experience when everything is finished.

Then - eureka - a human voice!

"Please tell us the patient's number, date of birth, and identity number."
I give these, but am further requested to give my "provider number" which is not the same as my NPI number. Fortunately, I can run out of my office again and find my office manager, who knows what this other number is.
I'm switched to another line. More ads, and more opportunities to later discuss my pre-authorization experience with another representative.
The next person I'm talking to sounds extremely bored, and requests the same information again. She wants to know if I am the "doctor's representative" and what my position is.
"I am the doctor."
Long silence.
More numbers are requested, including my Federal Tax ID number; the only number I know that they've left out is my Drug Enforcement Administration number - don't they want that? We are talking about a drug, after all. Again I give the patient's information.
"Did you already talk to Prime?"
Prime? Huh? "No," I say.
"You should have talked to them. I'll give you another number for them."
"They're not connected to you?"
"I can connect you." I take down the new number anyway.
More ads, more opportunities to talk with a representative about my review experience. Yet after a relatively short wait and no further disconnection I reach Prime!.
This "representative" is also surprised that I am the doctor calling for my patient. For the third time I'm asked to give the same patient information; I've already given my information four times. Do they need my Tax ID that badly?
Finally I receive my reward: "By the end of the day" I may receive a fax allowing me to explain my "clinical decision." I'm asked to give my fax and office numbers again.
"Why do you need this information again?"
"In order to make sure the fax goes through we need a backup number. Have you had any problems?"
"Yes. This whole system is a problem."
I've been on twenty-six minutes. And at the end of the day I might get a fax!
I opt not to discuss my review experience with another representative.

The Fax

Three hours later the fax arrives. On it is all the same information again, to be filled out longhand, plus a lot more.
I have to give all the patient's diagnoses; a history; all the reasons for selecting the medication and why alternatives cannot be used; and all the similar drugs she's been on, the dates and doses of when they were tried, why they didn't work; plus what other medications will be used in combination.
My patient has been on such drugs for decades. I have some of the information in my chart, but by no means all.
I will have to call her to get this information.

The Con

My experience is a tiny sampling of what millions deal with daily, frequently in life threatening forms. I know the potential results of even "successful preauthorizations." In one case I spent an hour on the phone attempting to get a generic drug okayed, finally obtaining agreement from the very concerned sounding health insurance pharmacist. However, the dose sent to the patient was one third what we agreed upon, a dose well below therapeutic level.
I understand that health care is complicated and expensive. I am willing to fill out paperwork explaining what my patients need, and am willing to talk to a pharmacist or "care manager" about why I am doing what I do.
However, this present system is clearly set up for obstruction aided by behavioral conditioning. In the old days they just sent the fax, without making you burn on the phone to get it. Instead, multiple requests for the same information are routine. Multiple phone disconnections are routine. I suspect the constant repetition while you wait of "opportunities" to review your "pre-authorization experience" is just a diabolical way to give the appearance of caring while infuriating people more.

Because the whole point of this process is to make you quit.

It works well. My physician friends don't bother any more. The patient in this example told me her internist refuses to do any pre-authorizations. Their PAs and medical assistants are also fed up.
Preauthorization for psychotherapy - don't even think about it.
So what happens to patients who are too sick or too disabled to call and defend themselves?
They pay up - or they don't get the treatment. And the insurance companies?
Big savings.

Who Pays?

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