jmj11 Posted March 4, 2019 Share Posted March 4, 2019 What do you think about this? Link to comment Share on other sites More sharing options...
Guest Paula Posted March 4, 2019 Share Posted March 4, 2019 Not surprised. When I have to do a physician to "physician" review for a prior authorization I often realize the physician I'm talking to is a retired dermatologist or pathologist or some odd other specialty, and they just follow protocol. usually it's for an MRI or for a particular drug, and they ask me questions about the patient and they don't have the patient record. Link to comment Share on other sites More sharing options...
Cideous Posted March 4, 2019 Share Posted March 4, 2019 Blood on his hands. Absolutely should be criminal... Link to comment Share on other sites More sharing options...
UGoLong Posted March 4, 2019 Share Posted March 4, 2019 It’s been a few years since I made those calls, but I agree the person on the other end is just following an algorithm. If you learn what it is, it seemed fairly easy to describe how your patient fits it or why his or her case is different. What it did do was take up a lot of my time.Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 4, 2019 Moderator Share Posted March 4, 2019 honestly I think they should charge him with involuntary manslaughter.... to much business in health care to many people motivated by pure profit and laziness.... Link to comment Share on other sites More sharing options...
mgriffiths Posted March 5, 2019 Share Posted March 5, 2019 I have yet to lose a peer-to-peer. Every time I have had to do one, I always start off reading word for word exactly from my clinic note and within the first 1-2 sentences the person on the other end stops me and provides an approval code. SOOOO frustrating. Their only goal is to make things more difficult so that either I won't bother or it's get lost in the paperwork and doesn't get done. Of course, the insurance company who denies coverage can never be sued for denying the test...but I can for not getting it done. Link to comment Share on other sites More sharing options...
jmj11 Posted March 6, 2019 Author Share Posted March 6, 2019 On 3/4/2019 at 3:31 PM, ventana said: honestly I think they should charge him with involuntary manslaughter.... to much business in health care to many people motivated by pure profit and laziness.... f they start with him, they will have hundreds in line for the same sentancing. Link to comment Share on other sites More sharing options...
mgriffiths Posted March 6, 2019 Share Posted March 6, 2019 1 hour ago, jmj11 said: f they start with him, they will have hundreds in line for the same sentancing. good Link to comment Share on other sites More sharing options...
turnedintoamartian Posted March 6, 2019 Share Posted March 6, 2019 I’ve got to echo mgriffiths as well and note every peer to peer I’ve done has been approved. It’s well known in my practice that it’s going to get approved but it’s a giant time suck. More time is spent on hold than conversation... Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 6, 2019 Moderator Share Posted March 6, 2019 15 hours ago, jmj11 said: f they start with him, they will have hundreds in line for the same sentancing. YES that is the point! funny sotry was a newish grad pa - not overly sure of myself had a PA for an LS spine MRI with weakness and diminished reflex Doc for the insurance company got on the line - Hi I am DOCTOR so and so - whom am I speaking with... He was immediately full of himself - and I was about a 2 yr PA I was 100% positive this guy needed and MRI - and I was pissed to have to call He starts to ask all these BS questions - which were feed from guidelines to avoided MRI which specifically stated if loss strength or reflex that MR should be done..... he was just asking odd questions Finally interrupted him and asked what he was for a doc - he was a freekin pathologist! I demanded to know when was the last time HE SAW A LIVING PATIENT IN THE OFFICE - crickets....... it was approved immediately... ------------------- it was this day that I lost the awe inspired view of Doc's..... Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted March 6, 2019 Administrator Share Posted March 6, 2019 When I was doing sleep medicine, so many of our patients had to go through AIM specialty health, I got to know the prior auth docs by name. Most of my requests were handled by one of 3 board certified sleep docs who were pretty reasonable, for the most part. Link to comment Share on other sites More sharing options...
SHU-CH Posted March 8, 2019 Share Posted March 8, 2019 This is certainly nothing new. I while back I met someone with a family member that processed claims in the insurance industry. They were basically told to deny every 10th claim without even looking at it. I imagine there is some percentage of these a practice writes off without a fight and it is free money for the insurance company. I'd imagine things are pretty much the same, except now it might be every 3rd claim. Link to comment Share on other sites More sharing options...
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