Patients and Physicians Speak Out

I have a patient with a crush injury to his foot who waited 2 months for appropriate imaging studies and then SIX months for approval to operate. Tell me our system is the best. Please. I have many examples. Everyday.

We have patients who have paid insurance for years, need spine surgery for pain, and because they don't meet criteria they are denied.

I had a patient in her late forties who had been a smoker since her early teens. She came in with hemoptysis and shortness of breath. A chest x-ray revealed a single 2 cm nodule in her left upper lung field. I wanted to get a CT of the chest to better characterize this as it was most likely lung cancer. The response from the insurance company was she could not have a CT scan until she had first undergone six weeks of physical therapy. Yes, you read that right. Physical therapy. I told the idiot on the other end of the phone that if 6 weeks of physical therapy could cure lung cancer, we would have a miracle on our hands. It still took three more phone calls and faxing over office notes before I could get the CT scan approved. It took almost 2 weeks.

I have 6 full time and 1 part time staff to support 1 physician and 1 physician assistant. They spend so much time with PA's and insurance issues that we struggle to answer the phone when a patient calls. It leads to frustration on everyone's part. It's getting worse, please help!

It is not uncommon for patients to change pharmacy benefit managers when changing health plans or for health plans to change their pharmacy benefit manager.  Physicians and patients get caught in the crossfire of endless forms and calls while waiting for meds, which they have successfully taken for years, are now questioned.  It is very difficult to reconstruct a person's previous med history when we have changed to a new EMR and then find it hard to justify to the PBM why the person ended up on the regimen that is working for them.  It is a waste of time and potentially dangerous.  These requests involve FDA-approved drugs and often generic medications.

I feel that prior-auth has been one of the worst things to affect physicians' lives, along with Medicare and insurance companies' constant assault on physicians’ ability to do the right thing in the most efficient manner for their patients. This is all labelled as "monitoring" so that patients are getting proper care. It is a huge wastage of resources. One can write a big dossier about everyday examples of this. I have heard from many many excellent physicians that this is the main driving force behind physicians' consideration of early retirement, and that includes myself.