by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
Any physician will tell you that prior authorizations – the process to get an insurance company’s approval (or denial) for an MRI, prescription drugs, and life saving treatments – are annoying and take away time from patient care. According to Medical Economics, as much as 25 percent of a medical practice’s day is consumed with dialing-in to insurers. See for yourself below:
On the flip side, the prior authorization maze is supposed to act as a cost-controlling tool for insurance companies. Maybe an MRI isn’t all that “medically necessary,” or perhaps there’s a lower-cost drug treatment available.
How exactly are prior authorizations conducted? Breaking news tells us that Aetna is now under investigation for not requiring its medical directors to look at patient charts when approving or denying treatment for patients. In some cases, the aftermath has been life-threatening. CNN has the details here.