Death By Prior Authorization

Huh? Check this out. What you will see is a very disturbing blog post. In it, you will see reportage of a case in which a patient died due to an insurance company’s inability/unwillingness to authorize a life-saving anti-seizure medication on a timely basis. So, who gets slapped with the anticipated wrongful death suit? The insurance company? Nope! The physician and pharmacy, both of which seem to have done their jobs. Yikes!

But there is a more general point here than litigation. This blog post got me to wondering as to what is the actual impact of this whole “prior auth” circus on healthcare in the United States. I am currently conducting two Habit Engineering SM studies in two different treatment areas with three different specialties. In virtually every single interview, I hear the respondent grouse about the amount of time it takes him or her to get preauthorization. Worse, I hear them complain that trying to pick a drug that will be covered by a patient’s drug plan without preauthorization is like shooting darts blindfolded. Much worse, I hear them tell me that they often don’t learn of a “miss” in this game for four or five days, when an aggravated patient calls to inform the doctor that there is no prescription to be picked up because coverage has been denied.

Bottom Line. Think of the things we talk about here. The doctor shortage, physician burnout, poor patient compliance. Then think about the negative impact that health insurance companies’ policies and procedures are having on all of these issues.

 Folks, there has got to be a better way to do all of this!

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