Preauthorizations: Friend Or Foe
Preauthorizations are becoming the bane of doctors’ existence. Preauthorizations are a ploy by insurance companies to not have to pay for medicines. They often require extensive paperwork to be done, multiple phone calls and faxes, and take up a huge amount of time for doctors’ offices. They do not generate any revenue for the doctor, and it is an additional expense that has to be passed on to the patient. Preauthorizations used to be exclusively for expensive medicines like growth hormone; however, now insurance companies can do preauthorizations for any medicine they want.
Why do insurance companies require preauthorizations? The answer is because they can! They know that many doctors will not fill out the forms and therefore, they do not have to pay for the more expensive medicines. By repeatedly denying and requiring additional paperwork, they can also stall and not have to pay for the medicines. Patients suffer by not getting their medicines.
Fortunately, in the state of California, Senate Bill 232 was passed in 2016 that tries to limit the abuse of doctors’ office by the insurance companies with preauthorization requirements. The bill was authored by Senator Ed Hernandez, who is an optometrist in West Covina, CA, and who spoke at one of Dr. Friedman’s symposiums. He is now running for lieutenant governor in California. The bill requires insurance companies to respond to and approve preauthorizations in 3 days, or 1 day if it is an emergency, such as when the patient is out of their medicine. It also requires insurance companies to accept a standardized 2-page form that is much more simple than the forms insurance companies require. If insurance companies do not respond to the provision of Senate Bill 232, complaints can be made by either the patient or the doctor to the Board of Managed Care and the insurance company and possibly the individual doing the denying can be subject to fines.
Although the bill was passed in California, Dr. Friedman interprets the bill to say it covers all patients seen and prescribed medicines in the State of California, even if the patient does live out of town.
There is also California State Law AB 974 (called the Gallegos law) that makes it unlawful for anyone to mandate a medication change for a patient if the patient is currently using that medication, is stable on that medication with no adverse effects, and if that medication is effective in the treatment of the patient’s medical condition. Dr. Friedman’s office uses this law if his patients are denied continued treatment of a medication found to be effective.
What can you do as patients? First of all, be patient with Dr. Friedman’s staff when they are trying to do preauthorizations for you and realize that they have to play this extensive game made up by the insurance company. You can also contact your state legislators to try to pass a similar bill in your state. Hopefully, the preauthorization issue will be resolved and patients will be able to get approval for the medicines in a timely manner. Preauthorizations might be a friend to insurance companies, but a foe to doctors and patients.
For more information or to make an appointment with Dr. Friedman, visit his website at goodhormonehealth.com.