Gotta keep the Irresponsibles in line
If you ever changed your name … ↑ think of the doors it would open ↑. Think of the insurance bullshit you could avoid:
Tallie Rose follows up with, “I called and they can’t even find the claim and had to kick it up to a manager because they can’t figure out WHAT they’re denying. Good stuff.”
This thread by Amy Faith Ho may be unrelated. But it’s related.* When Tallie Rose’s kid ends up in the ER with peritonitis, voila, no pre-authorization required.**
B/c not a shift goes by where a patient doesn’t land in the ER as a last resort when #priorauth denied or delayed them the outpatient care they needed.
Need your gallbladder taken out electively? Too late (waiting for auth), now you’re in the ED with cholecystitis. Had a “nodule” seen on a CT, but couldn’t get a repeat scan authorized…ever? Now it’s metastatic and you’re in the ED for crippling pain. DVT? No problem, started you on blood thinners. Oh, but your insurance wouldn’t cover it? Wait for it…now you’re hypoxic with submassive PEs. You’ve been having severe migraines, and insurance requires you to do a “trial of meds” before getting a MRI. The meds don’t cut it, you’re in the ED and turns out, you have an aneurysm. And it’s bleeding. The examples go on.
Why does this matter?
1. It’s terrible for patients
2. It stresses the healthcare system in ways it shouldn’t
3. It’s cumbersome and wasteful to insurers and clinicians both
35million priorauths submitted to @MedicareGov#MedicareAdvantage in a year – assuming 5 min/each and $20/hour of staff time (underestimated since this is physician/RN/admin blended time) that’s $58million of just labor cost. Not including denials/appeals…
So why does #priorauth exist?! To “contain costs” by insurers… Doesn’t sound terribly cost effective, does it?
$58 million in labor cost alone of initial submission, not including the labor cost of denials/appeals and not including the cost of ED/hospital stays that results from delays/denials… Sounds like it’s time to get rid of #priorauth, no?
That would make too much sense.
* Since Musk took over Twitter, ThreadReader no longer seems to work cleanly with it. I understand he’s some kinda rocket scientist.
** This sounds eerily like the barriers Republicans erect to getting SNAP and other government benefits, doesn’t it? You know, to keep the Irresponsibles from getting anything they don’t deserve.