Prior Authorizations

All doctors hate prior authorizations. Why? Because we ALL know that it is only based on saving insurers money. As their profits go up and their stocks increase, we physicians sit on the f%cking phone only to fight with an idiot on the other end. Or, better yet, we get an electronic prior authorization to be filled out via a portal. You spend a ton of time filling it out and it doesn’t matter because it gets rejected anyway. And then it’s back to waiting on the phone again. I really believe they just trying to piss us off for fun. Once again, we are treated as clerks and are put between the patient and the insurer. They are even doing this with generic meds now. God, I hate these insurance companies and PBMs.

Anyway, this just came out:

Building on data released earlier in 2019, which showed near-universal dissatisfaction with PA protocols, the AMA is again urging health plans to reduce the administrative burdens associated with the pre-approval process.

“While health plans and benefit managers contend that PA programs are important to control costs, providers often find these programs to be burdensome and barriers to the delivery of necessary patient care,” the professional organization wrote.

Here is my question. What do you think the health plans and benefit managers will do whey then see the AMA urging them to do something?

  1. Laugh until coffee comes out their noses
  2. Reply with a collective “Who gives a sh*t what the AMA wants?”
  3. Respond by giving their executives a higher bonus.
  4. Nothing. They listen to no one. They care about no one. It is their ball and their playground and until someone does something it about then it is their rules and screw everyone else.
  5. All of the above

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Prior Authorizations

  1. Kurt
    March 20, 2019 at 2:16 pm

    A big damnable item is someone is on a “higher priced” statin for years ’cause they can’t tolerate the cheaper stuff. Insurer mines their data and says to you they’re not going to pay for it anymore and ya gotta use the generic. You can substitute any drug you want here and it drives me crazy.
    Even though you tried the generic it doesn’t work and the Docs keep getting harassed. I say God “condemn to Hades” anyone who dupes a medical student to go into primary care in its current state.

    • Max
      March 23, 2019 at 8:08 am

      Amen.

  2. stevem64
    March 16, 2019 at 12:56 pm

    Prior authorizations are making practice impossible. It doesn’t matter: Regular insurance participating docs, DPC, Concierge Care, Cash only care…. We are all getting killed by this. You either do it yourself or you pay someone to do it. It is destroying our ability to take care of patients.

    Yet, I also blame the pharmaceutical companies. The prices on these drugs are totally out of control.

    I’m seeing lots of Trelegy inhaler advertisements as I watch the Basketball tournaments. The price is covered up when the reps come to the office: “One year of deductible waiver! What a deal! Cheaper because you only prescribe one inhaler for all three modes of therapy!”

    Yet, GoodRx says the cash price is $557 for 28 days. Somebody is paying for that. Of course insurance doesn’t want to cover it! It’s cheaper for you to die!

    Then, you have other issues: Lying insurance companies. If someone receives a prescription for 9 pills of Generic Maxalt, the insurance will claim they paid their own mail order pharmacy $300. Yet, the GoodRx price is less than $15 for cash pay. So, the insurance is lying about the burden of the medicine.

    It feels like the doctor and the patient are in a giant house of mirrors trying to figure out how to navigate care!

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