Re: The 112th Congress - The first Orange-American to be elected Speaker
Consider yourself lucky that you've never had to deal with them under duress -- doing so is confirmation enough that they're just a legalized mafia.
Come the Revolution, Hartford's a smoking pit.
I deal with them trying to get patients care. Love the prior authorization gig. They have some idiot who does not have a medical degree of any sort asking set questions regarding the appropriateness of my treatment or work up. They are not medically trained so they go by protocol with no insight or thought.
Example- someone came in with an acute illness. They have abnormal bloodwork indicating infection, fever, have passed out, have pain, sx are getting worse. The exam is indicative of something needing surgery. The nurse books the test. Needs prior auth before the patient can get test. We send the patient on ahead and pray.
The Nurse then spends 10 minutes on the phone getting someone at the insurance company who can screen my ordered test. The person asks questions for about 10 minutes making my nurse spell every diagnosis, clarify every symptom and requires that she tell them the billing code for every thing she just said. Following the script, the person then asks if this is life threatening. At this point my nurse who has just described in minute detail sx that should make this question a moot point, loses it and says sarcastically, "Yeah, if the dx is correct then the patient could rupture something and wouldn't he just be screwed!" The person ponders this and then says the nurse needs to speak with a clinical person as the screen in can't be OKd until that person makes sure the test is
really needed.
By now my nurse is making me wonder if she is going to find a way to physically reach thru the phone and strangle someone. Another pause, the clinical guru comes on the phone,
asks the same questions as the first person (she does, however not need it to be spelled). Hold please.........40 minutes after starting the odyssey we get an approval. The patient has been waiting 10 minutes at the test site.
This is unfortunately not unusual. Tell me again about the need to cut costs. I just paid my nurse for close to 3/4 of an hour to leave all her other duties so we can get one test. Then we get to pay her OT because the other work did not do itself and now she needs to catch up. The patient waited for a test. It is now late enough in the day that we won't get results until he has to go thru the ED to get the surgical consult. More $. More wasted resources.
Sure they tell you there are appeals but when you have something emergent then the appeal is not a timely option. There are times when the patient gets the test rejected and our only recourse is to send the patient acutely to the ER so they can order the test emergently there. This means the patient gets evaluated 2 times so the same test can be ordered and they can try the PA thing again!
You would expect that you could hold the insurance company liable but some cretin made them immune from culpability and they can make decisions that are not medically based with impunity. (OK so that was a bit of a rant

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