A new Biden administration rule released Wednesday aims to streamline the prior authorization process used by insurers to approve medical procedures and treatments.
Prior authorization is a common tool used by insurers but much maligned by doctors and patients, who say it’s often used to deny doctor-recommended care.
Under the final rule from the Centers for Medicare and Medicaid Services, health insurers participating in Medicare Advantage, Medicaid or the ObamaCare exchanges will need to respond to expedited prior authorization requests within 72 hours, and standard requests within seven calendar days.
The rule requires all impacted payers to include a specific reason for denying a prior authorization request. They will also be required to publicly report prior authorization metrics.
Why are we letting the insurance companies make decisions like doctors in the first place again again?
Because doctors have a financial incentive to order and perform/give expensive procedures and drugs that may not necessarily be medically necessary.
This is obviously a somewhat different situation, but I’d remind you that lots of doctors made a lot of money by unnecessarily prescribing Oxycontin that the spiraled into the opioid crisis.
It’s not unreasonable for there to be some kind of check, though to be clear, I’m not saying the current system is good. But, insurance just automatically paying for anything a doctor orders is open for abuse, and that needs to be addressed one way or another.
Some doctors made a lot of money. Most believed what they were told and prescribed medication they thought would help their patients.
Well said. I have a nerve disorder which is controlled by medication, but it took a long time to get there and, for a while, he tried me on different opioids. I could easily have gotten seriously addicted (I did go through withdrawal symptoms after I stopped, but I had no problem stopping), but he was doing whatever he could to try and help me with my pain. He wasn’t trying to make money, he was trying to make me feel better. And it took about three years, but he finally did.
Marketing by opiate manufactureres cooked up a small study that said certain opiates had slow release versions that were less addictive and doctors bought in for a while.
I would step back a little though and say the reason people actually need so many opiates in america ties into larger problems that cause the US to have far more injuries than other countries:
Over reliance on car infrastructure and commuting because improper zoning and lack of public transit
Poor labor protections and safety in workplaces
Gun fucking
There is nothing stopping it from being a retroactive investigation. Doctor prescribes it and then has to send evidence to the Insurance Company who can review it. If there’s a pattern of Bad behavior with one doctor they can press charges or something like that. But until then you’re holding up treatment on the suspicion of the possibility.
Wait, so where were these insurance companies then and why weren’t they acting as “checks” on these doctors? It couldn’t have just been a minor oversight by the insurance companies either, considering it did spiral into a nationwide crisis.
That’s a bullshit excuse (to be blunt). What you’re suggesting is that it’s the insurance companies job to police doctors who are doing harm to their patients. There is already a body that does this (or is supposed to): the medical board. If the insurance company feels that a doctor is abusing their privileges, then it needs to be taken up with the appropriate authorities. It does not mean causing further harm to the patient by denying possibly critical services.
We don’t have anyone to make better medical decisions than doctors. I certainly don’t want insurance company bureaucrats substituting their medical judgment for my doctor’s, even if my doctor sucks.