More about PA's "Prior Authorization"

For many patients and doctors offices this is a very difficult area!  Patients and doctors assume that if they A. Evaluated you  B. Come up with a diagnosis C. Come up with a treatment plan, then this will all occur.  This could not be further from the truth.  Every insurance company is different.  Even if you and another person have blue/cross or united health care.  They many have very different benefits.  Even if you work for the same company as another patient, they may have selected a "lesser" plan.  At times an MRI will be approved that day with no more then a list of diagnoses.  Other times they may want office notes.  Still others the doctor may need to have a physician to physician peer review.  This may all take a day or a week, depending upon schedules and when this can be accomplished between other patients.  Prior authorizations are required for some x-rays, MRI's, cat scans, durable medical equipment, medications and any other services that your insurance deems necessary.  It is important for each person to check their coverage and work with the doctors to get these approvals.   Although it may be very stressful for patients, remember that the doctor does want you to have this service and they are working on prior authorizations for other patients as well!

Prior Authorization is not a guarantee of payment!

If you work in a doctors office, these words can strike fear into the hearts of all personnel.  Whether it is for surgery, braces, newer medications, physical therapy, MRIs, CT scans and other medical tests, many require prior authorization.  This can cost the office staff an entire day in trying to track this down.  We as doctors are trained to know what is going on with our patients and what they need.  Unfortunately, we spend a large part of our day being told that we are not able to get what we feel is necessary for the best care of our patients.  This leads to a large amount of dissatisfaction among doctors.  There has to be a better way to treat our patients well and not spend time fighting with "Peggy" to get their treatment plan instituted!!