Surprise Ending: A Health Insurance’s Pre-Authorization Denial

Surprise Ending: A Health Insurance's Pre-Authorization Denial

The Dreaded Pre-Authorization Denial.

Health Insurance Weighs In.

After what felt to me like groveling, on my end, for a patient’s test to get approved (for the start of this story, and a journey through the intricacies of the frustrating peer-to-peer reviews, read Peer-to-Peer Pressure: Venting About Pre-Authorizations (Part I)) – knowing very well it was a necessary step in her workup – I was told No.

I felt the denial weigh down on my shoulders.

“Fine!” I raised my voice at the doctor on the other end.

“Deny the claim. But I’ll be writing this down in her chart. Ultimately, it’s you that’s going to be responsible if she ends up undiagnosed.”

I got off the phone and spent the next few minutes composing myself. We should no longer be taking things so personally, in our world of changing healthcare, because everything these days seems to be a battle. It has become us versus the health insurance companies. And sometimes it’s us versus the government-imposed rules. Sometimes it even ironically turns into us versus the very same patients we aim to treat. How did we get to this place?

I should know better, but I just can’t help but feel defeated because of all of this, these days.

So that’s where I was left.

I was left angry, staring at the phone, where my ‘peer’ had deemed my decision as unnecessary.

Ten Minutes Later, I Got a Call.

Surprise Ending: A Health Insurance's Pre-Authorization DenialIt was my peer, calling me back – a surprise twist of events.

I braced myself for what was to come.

He had ‘looked over my patient’s chart, and decided that I did, indeed, have a case, for ordering the test.’


I’d like to say that I was thrilled. That I felt vindicated. Even that I thanked him profusely, from the bottom of my heart.

But I didn’t.

The interaction had deflated me, and sucked every bit of positive energy from my well-intentioned being.

The entire process had taken out a chunk of my day – which happened to be a day off. It took up time. And effort. It left me angry and frustrated.

But you know what’s worse?

That it wasn’t the first, and it won’t be close to the last. Because this happens All. The. Time.

Prior-auth interactions deflate us, and belittle all of the effort we've put into our profession. They suck every bit of positive energy from our well-intentioned being to the point where we no longer want to do them. Click To Tweet

Fixing a Broken System.

We need to fix the system, at its core.

While I realize insurance giants set up these steps to avoid overspending (which, let’s be real, if done to save them money), there’s something wrong with how they’re being carried out. And the difficulties these steps present to the physicians, who just want to practice medicine.

We need this fixed because, ultimately, the patient suffers.

Major changes need to take place, and we need to start working together.

Let’s fight to make together for the changes we need, on all levels of medical care, and let’s do it now.

We need this (broken #healthcare system) fixed because, ultimately, the #patient suffers. #SoMeDocs Click To Tweet

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Surprise Ending: A Health Insurance's Pre-Authorization Denial

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3 Responses

  1. I have lived that scenario.
    However, I find the APPROVALS more annoying. Here’s why:
    If I want (the patient needs) something, it almost always gets done in the end- it’s the steps that one goes through: the denial, the appeal, the peer-to-peer, the added extra step (test,drug,etc) but in the end it happens.
    So, the process is just a waste of time, hoping that we (doctor or patient) just go away. But, most of won’t go away because we’re tireless advocates for our patients. Thus, we just get chipped away at. And get grumpier.
    If I was ultimately denied something that I truly felt was medically necessary, I would keep pushing until I got it.
    I have used your move of asking specifically the name and credentials of whomever is denying something.
    And I, too, have gotten the call
    back 10 mins later w the approval.
    Or more sneakily, the pt gets the approval in the mail and I get nothing

    1. Wow. I love this. It’s exactly why I set up the blog in the first place. To make connections with readers like you, who not only identify with what I write, but also have valuable info to add to the topic. Together, we will hopefully raise awareness on this practice, and maybe get some traction on changing this. In the meantime, I will keep asking for names… 🙂

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