Some sensible government action on insurance companies

[bedrock]

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Gov. Phil Scott signs bill limiting prior authorization, other health insurer practices - VTDigger

Lawmakers hope H.766 will alleviate the paperwork burden on doctors and nurses and improve care outcomes for patients. Insurance companies have warned that it could drive up premiums.

vtdigger.org

 

[pmrmd]

In the pain realm there should be no PA required for office-based procedures.

 

[SSdoc33]

interesting to see the effect. it is difficult to imagine a practice without prior auths at this point. it would be wonderful, but the biggest issue we have is with federal medicare -- and facet interventions specifically. i dont see that changing, unfortunately

 

[drrosenrosen]

Maybe I'm overly pessimistic, but this falls into the category of "careful what you wish for" for me. No PAs? Great! Now we're going to instead be auditing every chart and clawing back from you after service is rendered and you've been paid

 

[Laryngospasm]

Yes and people will abuse it and ruin it for everyone else.. and it will come back worse than before. I can see the article now “Vermont pain clinic bills for 23million dollars worth of facet based interventions in one month”

 

[drrosenrosen]

At least as it's set up currently the patient has some skin in the game - we're both being equally screwed by the insurance company. In fact, the pt probably moreso. If we stop PAs but increase audits and clawbacks, pt's already gotten their relief so they don't care if you get paid for it or not.

 

[Ferrismonk]

I honestly don't really mind prior authorization for procedures for chronic pain by itself, as long as the rules are clearly spelled out of course, and I really think that if a procedure is authorized it should absolutely also be a guarantee of payment.

 

[lobelsteve]

Dallas doctors plead guilty in $45 million health care fraud over fake pain injections

Two Dallas doctors gave patients fake injections for pain management.

www.dallasnews.com

Then there is this.

 

[powermd]

I honestly don't really mind prior authorization for procedures for chronic pain by itself, as long as the rules are clearly spelled out of course, and I really think that if a procedure is authorized it should absolutely also be a guarantee of payment.

My suggestion would be, #1) Ins pays $50 extra if the procedure is authorized. The whole point is that it saves them money- great, let them pay for the extra work on our end if we've met their criteria. #2) Yes, PA needs to be an absolute guarantee of payment. They need some skin in the game. #3) No gotcha time limit BS. Once authorized, there is no time limit on the procedure. The doctor gets to decide if the procedure is no longer needed, not some bogus arbitrary expiration date.