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Saturday, October 13, 2018

Prior Authorizations: Who is Responsible for the Death of a Patient when Insurers Practice Medicine?

This tragic story is an example of the co-fiduciary obligation alluded to in my post on September 28, 2018. I spent hours and hours over the past two weeks trying to get a prior authorization on behalf of a patient. I couldn't even speak to the same medical director twice because this particular insurance company had a different medical director assigned by day of the week and each medical director was not even in the same state, much less the same office, and they were general practitioners, not specialists in the matter to be discussed. One even stated she did not review the case and did not have the computer open in front of her because she was walking briskly down the sidewalk to an afternoon meeting. After each unresolved contact, the insurer would close the case so when I called back I had to request the case to be reopened and start anew. The sad part is that this is not atypical when dealing with health insurers. This can't be patient-centered or patient-responsive care... 😔
from Rajesh Harrykissoon, MD

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