Evil-core

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sloh

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“Another type is more lucrative, providing an incentive for EviCore to cut costs, former employees said. Known as risk contracts, EviCore takes on the responsibility for paying claims. As an example, say an insurer spends $10 million a year on MRIs. If EviCore keeps costs below that figure, it pockets the difference. In some cases, it splits the savings with the insurance company.

“Where you really made your money was on a risk model,” a former EviCore executive said. “Their margins were exponentially higher.”

Insurers do not make explicit demands for more denials, a former EviCore sales executive said, Instead, they asked about “controlling the spend” — the amount of money paid out on certain procedures, he said. Nor would EviCore always use the word “denials” — they employed circumlocutions like “inappropriate determinations.”

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Prior authorization requests for radiology imaging services had dropped to 3,629, a decline of 16%. Cardiology requests had plummeted even more — down 38% in a little more than a year. Doctors had simply stopped asking for procedures for their patients.

An EviCore executive called this the “sentinel effect” at a legislative hearing in Kansas. It is like the sheriff coming to town. Once doctors know EviCore is watching, they make fewer inappropriate prior authorization requests, he said.
 
State and federal regulators rarely impose onerous penalties on companies like EviCore.

Connecticut’s Insurance Department recently reviewed EviCore and Carelon. It found no problems with Carelon. EviCore was fined $16,000 this year for more than 77 violations found in a review of 196 files. EviCore is also accredited by two trade associations, which review companies periodically for compliance with industry standards.

Holding the companies legally responsible for their decisions is also difficult. In 2022, Carelon settled a lawsuit for $13 million that alleged the company, then called AIM, had used a variety of techniques to avoid approving coverage requests. Among them: The company set its fax machines to receive only 5 to 10 pages. When doctors faxed prior authorization requests longer than the limit, company representatives would deny them for failing to have enough documentation. Carelon denied the allegations in court and admitted no fault. A spokesperson declined to comment on the lawsuit.
 
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Lawsuits against employer-funded health plans, like the one Cupp had with United, must be tried in federal court, where case law favors insurance companies. For instance, insurers found at fault do not pay punitive damages, only the cost of treatment.
 
Lawsuits against employer-funded health plans, like the one Cupp had with United, must be tried in federal court, where case law favors insurance companies. For instance, insurers found at fault do not pay punitive damages, only the cost of treatment.

So the worst that can happen to them is, if you go through all the effort of litigation, they have to pay what they should’ve paid upfront but years later.

What a great system
 
Whelp, had one too awful not to share this morning. Full disclosure, it wasn’t Evicore. Even they cover this. Had a PA deny IGRT for 55/20 for a definitive T2 bladder tumor. Got to P2P thinking we could work this out. I’m typically very nice with them. I explained I was treating an empty bladder to minimize field size and needed IGRT to ensure the bladder is empty and in the field. You know, standard practice and all. The clown on the other end of the line who claimed to be a rad onc told me I could sim with a full bladder to make sure my fields were big enough without using IGRT. Then went to my favorite line, “there is no evidence IGRT is necessary for bladder treatment.”

This right here is my issue with how EBM gets distorted by these companies. Take something that’s pretty well established in almost all tested areas and add enough qualifiers to say, well it’s not proven for that particular setting.
 
Whelp, had one too awful not to share this morning. Full disclosure, it wasn’t Evicore. Even they cover this. Had a PA deny IGRT for 55/20 for a definitive T2 bladder tumor. Got to P2P thinking we could work this out. I’m typically very nice with them. I explained I was treating an empty bladder to minimize field size and needed IGRT to ensure the bladder is empty and in the field. You know, standard practice and all. The clown on the other end of the line who claimed to be a rad onc told me I could sim with a full bladder to make sure my fields were big enough without using IGRT. Then went to my favorite line, “there is no evidence IGRT is necessary for bladder treatment.”

This right here is my issue with how EBM gets distorted by these companies. Take something that’s pretty well established in almost all tested areas and add enough qualifiers to say, well it’s not proven for that particular setting.

I no longer even bother having conversations with them. I tell them what I want, they tell me why I can't have it, I tell them I will appeal and it will eventually get approved. Total time on call less than 30 seconds. Waste of time to do anything else.
 
I no longer even bother having conversations with them. I tell them what I want, they tell me why I can't have it, I tell them I will appeal and it will eventually get approved. Total time on call less than 30 seconds. Waste of time to do anything else.
For some things I agree. This is the first definitive IGRT case I’ve had denied by any of them.

Big picture, I agree with your approach. You figure out what they can/will approve if you just show up for the call and what is a total waste of time. I can’t remember the last time I was genuinely surprised how one of these turned out. Heck, yesterday I got Evicore to approve IMRT for a different bladder case without going to appeal. I despise the hoops they make me jump through, but for definitive cases, I pretty much get what I want from them.
 
Whelp, had one too awful not to share this morning. Full disclosure, it wasn’t Evicore. Even they cover this. Had a PA deny IGRT for 55/20 for a definitive T2 bladder tumor. Got to P2P thinking we could work this out. I’m typically very nice with them. I explained I was treating an empty bladder to minimize field size and needed IGRT to ensure the bladder is empty and in the field. You know, standard practice and all. The clown on the other end of the line who claimed to be a rad onc told me I could sim with a full bladder to make sure my fields were big enough without using IGRT. Then went to my favorite line, “there is no evidence IGRT is necessary for bladder treatment.”

This right here is my issue with how EBM gets distorted by these companies. Take something that’s pretty well established in almost all tested areas and add enough qualifiers to say, well it’s not proven for that particular setting.
Recently had to go to appeal for same exact case. They denied IMRT...I didn't even bother and threw a 3 field plan on a la BC2001. I could not abide the lack of CBCT...come on...any practicing radonc knows that bladder emptying is not that reliable in this patient population and also gets a bit worse over the course of treatment.

I think my note to them was...IMRT has already been denied and my present 3 field plan, with a standard margin relative to the empty bladder, is not meeting any aspirational goals regarding small bowel dose. This dose will only increase as I attempt to accommodate a lack of visualization of bladder during the course of treatment, resulting in a higher likelihood of both severe acute and late bowel toxicity in this medically frail patient.

It got approved.
 
I had chatgpt throw this together in 10 seconds, feel free to play with the prompt (ended up being a little over 1000 words)

"write a 3000 word meandering, condescending letter about prior authorizations in medicine"

ChatGPT said:​


Certainly! Here’s a structured yet meandering letter that explores the topic of prior authorizations in medicine, infused with a condescending tone.


I trust this letter finds you in the utmost comfort, perhaps enjoying a leisurely afternoon pondering the finer intricacies of life and medicine. As someone who has navigated the labyrinthine corridors of healthcare with a keen eye (and, dare I say, a modicum of experience), I feel compelled to enlighten you about a particularly fascinating aspect of modern medicine: prior authorizations.
Now, I know that for the uninitiated, prior authorization might seem like just another bureaucratic hurdle, a mere administrative necessity in the grander scheme of patient care. However, allow me to elucidate the depths of this seemingly innocuous requirement. Prior authorization is, at its core, an intricate dance between healthcare providers and insurance companies—an elaborate tango that often leaves patients feeling dizzy and disoriented.

The Essence of Prior Authorization
Picture this: a patient arrives at their physician's office, eager for relief from a medical condition that has plagued them. The physician, armed with the latest medical knowledge and a genuine desire to help, prescribes a treatment—perhaps a medication that promises to alleviate their suffering. But wait! Before this miracle can occur, the physician must embark on a journey through the bureaucratic maze of prior authorization.
Oh, the thrill of it! One can hardly contain the excitement of dialing into the insurance company, engaging in a delightful exchange of information, only to be met with a multitude of questions that seem designed to test not only the physician’s medical knowledge but also their patience. It’s as if the insurance company delights in transforming straightforward clinical decisions into a complex riddle, challenging physicians to justify every aspect of their recommended treatment.

The Art of Justification
Now, let us consider the “justification” process—what a splendid term! It implies that physicians must somehow defend their choices as if they were being scrutinized by an academic board rather than simply advocating for their patients’ health. This is where the condescending nature of the system truly reveals itself. Imagine a physician, who has spent years honing their skills and knowledge, now forced to articulate the nuances of their decision to an individual who may or may not possess the same level of medical understanding. Ah, the irony!
The physician must document clinical rationales, provide extensive medical history, and perhaps even submit copies of lab results—all to prove that the treatment is not just necessary but absolutely essential. This process could, in theory, be streamlined to benefit patient care, but alas, we find ourselves mired in a quagmire of red tape, seemingly designed to test the limits of one’s resolve.

Patients: The Unwitting Participants
Let’s not overlook the impact on patients, shall we? Patients, who come to healthcare with trust in their providers, often find themselves caught in the crossfire of this bureaucratic battle. “Why isn’t my medication approved?” they wonder, bewildered by the labyrinthine processes that govern their health. The lack of transparency and the delays can be maddening, transforming what should be a straightforward path to wellness into a drawn-out ordeal.
The truth is, most patients are blissfully unaware of the machinations behind their healthcare decisions. They trust their physicians to act in their best interests, and yet, they become unwitting participants in a bureaucratic dance that prioritizes paperwork over patient care. How delightfully ironic! It’s almost as if we’re living in a Kafkaesque novel, where the heroes of the story—the physicians—are relegated to the role of mere players in a game dictated by faceless insurance entities.

The Insurance Perspective
Now, let’s take a moment to consider the insurance companies—the custodians of healthcare cost management. One might argue that they exist to safeguard against unnecessary expenditures, to protect the financial well-being of the masses. And yet, one cannot help but wonder if their approach often borders on the absurd. The very systems designed to provide oversight can sometimes resemble a well-orchestrated farce, where medical necessity is overshadowed by the arcane rules of coverage.
How charmingly self-righteous these companies must feel as they reject claims based on obscure guidelines! They wield their power with a flair that could put a seasoned stage performer to shame. “No, this medication is not covered under your current plan,” they declare, as if delivering the punchline of a particularly dry joke. And in the process, they forget that behind every claim is a real person, struggling with real health issues.

The Cost of Delays
Ah, delays—those wonderful moments where time seems to stretch indefinitely! The waiting game played by patients and physicians alike often results in heightened anxiety, worsened medical conditions, and in some unfortunate cases, irreversible health consequences. Is this the cost we’re willing to pay for the dubious honor of navigating the prior authorization process? I daresay, it’s a heavy toll indeed.
The question arises: how do we balance the need for cost control with the imperative of timely patient care? It’s a conundrum that has confounded many. Surely, a more streamlined approach could exist—one that prioritizes patient outcomes while still addressing the need for oversight. However, such a system would require innovation, a willingness to challenge the status quo, and a recognition that healthcare is, at its core, a human endeavor.

Calls for Change
As I pen this letter, I cannot help but feel a glimmer of hope for the future of prior authorizations. Perhaps there lies a path forward—one that doesn’t involve bureaucratic labyrinths but rather embraces efficiency, compassion, and understanding. It is conceivable that technology could play a role in this transformation. Imagine a world where prior authorizations are managed seamlessly through digital platforms, where physicians can engage with insurers in real-time, streamlining approvals and eliminating unnecessary delays.
Such an advancement would require collaboration between all stakeholders—physicians, insurers, and, of course, patients. It is a lofty dream, I know, but one worth pursuing. The goal would be to create a system that honors the expertise of healthcare providers while ensuring that patients receive the care they need without undue burden.

A Conclusion of Sorts
In closing, dear [Recipient's Name], I urge you to reflect upon the complexities of prior authorization in our healthcare system. It is not merely an administrative requirement; it is a reflection of the broader challenges we face in delivering quality care. As we continue to navigate this intricate landscape, let us strive for a future where patient care is prioritized over paperwork, where the art of medicine is unshackled from the chains of bureaucracy.

I appreciate your time in considering these musings, and I sincerely hope that they resonate with you in some capacity. After all, in this grand tapestry of healthcare, we all play a role—some more significant than others, of course.

Warm regards,
[Your Name]
[Your Credentials] (if applicable)
 
I had chatgpt throw this together in 10 seconds, feel free to play with the prompt (ended up being a little over 1000 words)

"write a 3000 word meandering, condescending letter about prior authorizations in medicine"

ChatGPT said:​


Certainly! Here’s a structured yet meandering letter that explores the topic of prior authorizations in medicine, infused with a condescending tone.


I trust this letter finds you in the utmost comfort, perhaps enjoying a leisurely afternoon pondering the finer intricacies of life and medicine. As someone who has navigated the labyrinthine corridors of healthcare with a keen eye (and, dare I say, a modicum of experience), I feel compelled to enlighten you about a particularly fascinating aspect of modern medicine: prior authorizations.
Now, I know that for the uninitiated, prior authorization might seem like just another bureaucratic hurdle, a mere administrative necessity in the grander scheme of patient care. However, allow me to elucidate the depths of this seemingly innocuous requirement. Prior authorization is, at its core, an intricate dance between healthcare providers and insurance companies—an elaborate tango that often leaves patients feeling dizzy and disoriented.

The Essence of Prior Authorization
Picture this: a patient arrives at their physician's office, eager for relief from a medical condition that has plagued them. The physician, armed with the latest medical knowledge and a genuine desire to help, prescribes a treatment—perhaps a medication that promises to alleviate their suffering. But wait! Before this miracle can occur, the physician must embark on a journey through the bureaucratic maze of prior authorization.
Oh, the thrill of it! One can hardly contain the excitement of dialing into the insurance company, engaging in a delightful exchange of information, only to be met with a multitude of questions that seem designed to test not only the physician’s medical knowledge but also their patience. It’s as if the insurance company delights in transforming straightforward clinical decisions into a complex riddle, challenging physicians to justify every aspect of their recommended treatment.

The Art of Justification
Now, let us consider the “justification” process—what a splendid term! It implies that physicians must somehow defend their choices as if they were being scrutinized by an academic board rather than simply advocating for their patients’ health. This is where the condescending nature of the system truly reveals itself. Imagine a physician, who has spent years honing their skills and knowledge, now forced to articulate the nuances of their decision to an individual who may or may not possess the same level of medical understanding. Ah, the irony!
The physician must document clinical rationales, provide extensive medical history, and perhaps even submit copies of lab results—all to prove that the treatment is not just necessary but absolutely essential. This process could, in theory, be streamlined to benefit patient care, but alas, we find ourselves mired in a quagmire of red tape, seemingly designed to test the limits of one’s resolve.

Patients: The Unwitting Participants
Let’s not overlook the impact on patients, shall we? Patients, who come to healthcare with trust in their providers, often find themselves caught in the crossfire of this bureaucratic battle. “Why isn’t my medication approved?” they wonder, bewildered by the labyrinthine processes that govern their health. The lack of transparency and the delays can be maddening, transforming what should be a straightforward path to wellness into a drawn-out ordeal.
The truth is, most patients are blissfully unaware of the machinations behind their healthcare decisions. They trust their physicians to act in their best interests, and yet, they become unwitting participants in a bureaucratic dance that prioritizes paperwork over patient care. How delightfully ironic! It’s almost as if we’re living in a Kafkaesque novel, where the heroes of the story—the physicians—are relegated to the role of mere players in a game dictated by faceless insurance entities.

The Insurance Perspective
Now, let’s take a moment to consider the insurance companies—the custodians of healthcare cost management. One might argue that they exist to safeguard against unnecessary expenditures, to protect the financial well-being of the masses. And yet, one cannot help but wonder if their approach often borders on the absurd. The very systems designed to provide oversight can sometimes resemble a well-orchestrated farce, where medical necessity is overshadowed by the arcane rules of coverage.
How charmingly self-righteous these companies must feel as they reject claims based on obscure guidelines! They wield their power with a flair that could put a seasoned stage performer to shame. “No, this medication is not covered under your current plan,” they declare, as if delivering the punchline of a particularly dry joke. And in the process, they forget that behind every claim is a real person, struggling with real health issues.

The Cost of Delays
Ah, delays—those wonderful moments where time seems to stretch indefinitely! The waiting game played by patients and physicians alike often results in heightened anxiety, worsened medical conditions, and in some unfortunate cases, irreversible health consequences. Is this the cost we’re willing to pay for the dubious honor of navigating the prior authorization process? I daresay, it’s a heavy toll indeed.
The question arises: how do we balance the need for cost control with the imperative of timely patient care? It’s a conundrum that has confounded many. Surely, a more streamlined approach could exist—one that prioritizes patient outcomes while still addressing the need for oversight. However, such a system would require innovation, a willingness to challenge the status quo, and a recognition that healthcare is, at its core, a human endeavor.

Calls for Change
As I pen this letter, I cannot help but feel a glimmer of hope for the future of prior authorizations. Perhaps there lies a path forward—one that doesn’t involve bureaucratic labyrinths but rather embraces efficiency, compassion, and understanding. It is conceivable that technology could play a role in this transformation. Imagine a world where prior authorizations are managed seamlessly through digital platforms, where physicians can engage with insurers in real-time, streamlining approvals and eliminating unnecessary delays.
Such an advancement would require collaboration between all stakeholders—physicians, insurers, and, of course, patients. It is a lofty dream, I know, but one worth pursuing. The goal would be to create a system that honors the expertise of healthcare providers while ensuring that patients receive the care they need without undue burden.

A Conclusion of Sorts
In closing, dear [Recipient's Name], I urge you to reflect upon the complexities of prior authorization in our healthcare system. It is not merely an administrative requirement; it is a reflection of the broader challenges we face in delivering quality care. As we continue to navigate this intricate landscape, let us strive for a future where patient care is prioritized over paperwork, where the art of medicine is unshackled from the chains of bureaucracy.

I appreciate your time in considering these musings, and I sincerely hope that they resonate with you in some capacity. After all, in this grand tapestry of healthcare, we all play a role—some more significant than others, of course.

Warm regards,
[Your Name]
[Your Credentials] (if applicable)
The world will be a better place once we're eliminated.
 
The world will be a better place once we're eliminated.
vine humans GIF
 
Recently had to go to appeal for same exact case. They denied IMRT...I didn't even bother and threw a 3 field plan on a la BC2001. I could not abide the lack of CBCT...come on...any practicing radonc knows that bladder emptying is not that reliable in this patient population and also gets a bit worse over the course of treatment.

I think my note to them was...IMRT has already been denied and my present 3 field plan, with a standard margin relative to the empty bladder, is not meeting any aspirational goals regarding small bowel dose. This dose will only increase as I attempt to accommodate a lack of visualization of bladder during the course of treatment, resulting in a higher likelihood of both severe acute and late bowel toxicity in this medically frail patient.

It got approved.
I was asked for a letter of necessity. I made it very generic about exceeding acceptable dosimetric small bowel dosing even with an empty bladder and needing to confirm appropriate tumor coverage. It should surprise on one, but I got it approved. Then I was asked for a LON regarding IMRT. Again, very generic stating even with IMRT I was only able to cover 90% of the PTV margin to meet bowel constraints. I didn't do a comparison plan or put any effort to showing just how horrible a 3D plan would be for this particular case. Also got IMRT approved.

Its all a song and dance. Im not honestly sure they even read the letters. I am convinced they are banking on people just not doing them. This crap is insanely annoying, but it is essential you figure out what you can get paid for. Even with EvilCore, I can almost always get IGRT and IMRT for definitive cases if I go through the motions of their dog and pony show.
 
I was asked for a letter of necessity. I made it very generic about exceeding acceptable dosimetric small bowel dosing even with an empty bladder and needing to confirm appropriate tumor coverage. It should surprise on one, but I got it approved. Then I was asked for a LON regarding IMRT. Again, very generic stating even with IMRT I was only able to cover 90% of the PTV margin to meet bowel constraints. I didn't do a comparison plan or put any effort to showing just how horrible a 3D plan would be for this particular case. Also got IMRT approved.

Its all a song and dance. Im not honestly sure they even read the letters. I am convinced they are banking on people just not doing them. This crap is insanely annoying, but it is essential you figure out what you can get paid for. Even with EvilCore, I can almost always get IGRT and IMRT for definitive cases if I go through the motions of their dog and pony show.
Kudos to you. The Evil-Core folks in our neck of the woods require color DVH comparisons between 3D and IMRT. Maybe with a lot of goading and time wasting, I can get it done, but why bother? The patient's care simply gets significantly delayed. When I see "United" PPO or Advantage on the patient's chart I don't even bother with asking for IMRT (for rectal cancer for instance) - I just go with 3D. Which I suppose is the point . . .

I am at a bit of a low this morning because a blood transufsion dependent patient of mine with pancreatic cancer died while we were waiting for SBRT auth. In a particularly cruel twist of fate, I got an unscheduled call from a reviewer denying SBRT and a few minutes later the patient's wife contacted me and told me he passed.

I want to be clear, prior auth in medical care is the real "death panel" that people are always screaming about during attempts at insurance reform. When people ask me about Medicare Advantage plans - I am clear with them that the reason certian plans are cheaper is that they deny care and hope you die. Just take a look at United stock and you can see the success of this strategy.

This is the true moral outrage that, at times, makes me want to hang it up.
 
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Kudos to you. The Evil-Core folks in our neck of the woods require color DVH comparisons between 3D and IMRT. Maybe with a lot of goading and time wasting, I can get it done, but why bother? The patient's care simply gets significantly delayed. When I see "United" PPO or Advantage on the patient's chart I don't even bother with asking for IMRT (for rectal cancer for instance) - I just go with 3D. Which I suppose is the point . . .

I am at a bit of a low this morning because a blood transufsion depednent patient of mine with pancreatic cancer died while we were waiting for SBRT auth. In a particularly cruel twist of fate, I got an unscheduled call from a reviewer denying SBRT and a few minutes later the patient's wife contacted me and told me he passed.

I want to be clear, prior auth in medical care is the real "death panel" that people are always screaming about during attempts at insurance reform. When people ask me about Medicare Advantage plans - I am clear with them that the reason certian plans are cheaper is that they deny care and hope you die. Just take a look at United stock and you can see the success of this strategy.

This is the true moral outrage that, at times, makes me want to hang it up.
You will get no argument from me. What I don't understand is the regional variation in PA denials. In my region, they are super aggressive with diagnostic imaging requests and most anything relating to IGRT or IMRT for palliative cases. SBRT for oligomets? Don't bother asking even if its a re-treatment. The one apparent exception is pancreatic SBRT. Its my go to preference for most palliative/unresectable cases and I don't believe I've ever had any PA issues for pancreatic SBRT. Im not sure I've even had to write a LOMN let alone take a P2P for it. If my only focus were the bottom line and I had the power to deny pancreatic SBRT in the bay area, why in the world wouldn't I do the same in the midwest? Is it a way to maintain plausible deniability against uniformly denying SOC therapies and claim to consider things on a case-by-case basis?
 
You will get no argument from me. What I don't understand is the regional variation in PA denials. In my region, they are super aggressive with diagnostic imaging requests and most anything relating to IGRT or IMRT for palliative cases. SBRT for oligomets? Don't bother asking even if its a re-treatment. The one apparent exception is pancreatic SBRT. Its my go to preference for most palliative/unresectable cases and I don't believe I've ever had any PA issues for pancreatic SBRT. Im not sure I've even had to write a LOMN let alone take a P2P for it. If my only focus were the bottom line and I had the power to deny pancreatic SBRT in the bay area, why in the world wouldn't I do the same in the midwest? Is it a way to maintain plausible deniability against uniformly denying SOC therapies and claim to consider things on a case-by-case basis?
My assumption is that part of the regional variation comes from differences in payor contracts. If pancreatic SBRT reimburses disproportionally well with a major payor in the Bay Area, there's more incentive to deny more of those cases.
 
My assumption is that part of the regional variation comes from differences in payor contracts. If pancreatic SBRT reimburses disproportionally well with a major payor in the Bay Area, there's more incentive to deny more of those cases.
It's crazy to me that different Medicare LCDs make different medical necessity decisions for the exact same icd10 code
 
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I just had a surprisingly reasonable discussion with an Evicore reviewer. It lifted the pall a little.
My discussions with them are usually fine. They typically either quickly approve or tell me where the algorithm simply won’t budge no matter what I say and I will need to appeal.

My biggest issue is the amount of wasted resources that go into stupid things like getting IMRT for definitive prostate cancer or a post-treatment PET for a primary cervical cancer. You have to remember, not only does 5 min of my time here and there add up and annoy me, the administrative resources we don’t see pile up much faster and increase overhead. Are large health systems just going to eat that cost? Of course not. Super aggressive PA systems pose as a way to avoid waste but I am 100% certain their cost analyses are highly flawed and don’t account for how their actions ultimately affect the cost of healthcare.

I realize nothing I said is a surprise to anyone. I just literally got off the phone for another silly PA request which was quickly approved. You you, because SOC and all.
 
My discussions with them are usually fine. They typically either quickly approve or tell me where the algorithm simply won’t budge no matter what I say and I will need to appeal.

My biggest issue is the amount of wasted resources that go into stupid things like getting IMRT for definitive prostate cancer or a post-treatment PET for a primary cervical cancer. You have to remember, not only does 5 min of my time here and there add up and annoy me, the administrative resources we don’t see pile up much faster and increase overhead. Are large health systems just going to eat that cost? Of course not. Super aggressive PA systems pose as a way to avoid waste but I am 100% certain their cost analyses are highly flawed and don’t account for how their actions ultimately affect the cost of healthcare.

I realize nothing I said is a surprise to anyone. I just literally got off the phone for another silly PA request which was quickly approved. You you, because SOC and all.
Yeah, sure. This was less straightforward and a reasonable colleague-to-colleague discussion. Didn't even have to do a plan comparison. I was expecting the reviewer to say my hands are tied submit appeal directly to insurance, etc.
 
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