Pre Approval

Well there seems to be a movement in healthcare away from having to get pre-approval for everything, even if that same trend isn’t happening for husbands. Like my friend Joe who failed to get the okay to leave his 2-year-old unattended while he mowed the grass. "I'm not sure how I lost him," Joe says, "I only know that my wife reminds of this every year."

Several laws are in the works – including one moving through Congress that if enacted would require Medicare Advantage insurers to publicly share their pre-approval rules and denial rates. That may not move the needle right away for doctors and therapists but insurers are at least now more willing to waive pre-approval for providers who meet a certain standard, or for patient situations where requiring pre-approval makes little sense (like Washington insurer Premera has halted pre-authorization for biomarker tests for certain cancer patients). The cost to pre-approve can be significant – for insurers it can be hundreds per case, and for practices it can mean taking clinical staff away from patients.   Insurers often kick back requests faster than the Roadrunner.  “It’s fairly automatic - we usually require a couple weeks of progress notes when it’s a reauthorization – sort of why we exist,” quipped one of my basketball buddies who works as a utilization analyst for a northeast insurer.  

Lifting pre-approval requirements is probably good for patients on the whole, but candidly I’m not holding my breath that this same trend will sweep through my house.  God love her, but my bride requires me to get pre approval for many things, likely because I let my 3-year-old run free during a birthday party at the mall in 2006, while I typed on my laptop in the food court. I didn’t pre-verify birthday etiquette. “Did you even know Jack was running naked through Filene’s Basement?” Bridget said during our post-mortem. “Well, no, but in my defense I managed to get him home with his clothes on. So we got that going for us.”