Please indulge me in a little rant, in what I am calling, Savvy? NO!
This one is about prior authorizations that are increasingly required by our insurance companies before they agree to fill prescriptions or authorize payment for procedures.
Here is Wikipedia’s definition of Prior Authorization: Prior authorization is a check run by some insurance companies or third party payers before they will agree to cover certain prescribed medications or medical procedures. There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. A failed authorization can result in a requested service being denied, or an insurance company requiring the patient to go through a separate process known as “step therapy” or “fail first”. Step therapy dictates that a patient must first see unsuccessful results from a medication or service preferred by the insurance provider, typically considered either more cost effective or safer, before the insurance company will cover a different service
The process is intended to act as a safety and cost-saving measure, although it has received criticism from physicians (and patients, emphasis mine) for being costly and time-consuming.
I trust my medical professionals to prescribe the best medications and order the necessary tests for my condition. When my endocrinologist (or any other hcp) writes an order, the very last thing I need is for my insurance company to DENY me or require my doctor and his staff to take precious time out of their day helping patients to JUSTIFY their choice of treatment. My doctor is my doctor, not some insurance agent!
It is an outrageous overstepping of their role, trying to usurp the ability of my doctor to provide care and treatment for me.
And while I’m at it, someone needs to take a look at the insurance personnel who decide which medications are eligible on their formulary. No doubt, they “prefer” medications for which they pay the least. But that doesn’t equate to the best medication for the patient!
Insurance reform, anyone???
Got any opinions? Please comment!