F*****g bureaucracy, man. Medical make-work.

[Aristus]

I just had to fill out an insurance authorization for a patient who needs a new prosthesis for his below-the-knee amputation. The insurance company wants to know why they should have to pay for it.

There was a line on the form:

PROGNOSIS:

I wrote: "His leg isn't going to grow back."

They're just going to have to accept that as my answer.

[Jilly_in_VA]

1. Good for you!

(from a one-time case manager who got sick of dealing with the idiocy)

[Docreed2003]

2. I'm so over the prior approval process

It seems like every insurance provider has made this process more difficult. My staff spends way too much time trying to navigate that system and it only delays care. I have a stack of prior Auths that we're working through today for cases that are booked for next week. I empathize with your struggle and frustrations!

[asiliveandbreathe]

3. Ah, yes, insurance co. bureaucracy..so sorry gentleman had to have

amputation, and now this??.. - Have been dealing with ins. co. almost on a daily basis for 2 years..what I have learned..ins. co. will dictate who can have an MRI..doing Dr. work, of course..(CT Scan approved)..okay..able to get some of same results..

Dr. ofc PCP sent wrong group ID to this Dr (specialist), that Dr. (specialist), and you know what, you can never get through on the phone..one day took me 4 hours getting referred to this billing dept..that billing dept..AND THEN, until I practically choked them over the phone, I asked "Do you have a copy of hubbys medical card? Yes. - Compare the group ID to the group ID on the Hold Order..OH, I see - clean up in aisle 8...

I proceeded to request clean orders to be put up in the patient portal..so this does not continue to cycle through with wrong group ID..the problem, as I peeled back the onion, started in the PCP ofc...needed blood work, ultra sound..etc..endoscopy, cataract surgery, etc etc etc..NO, not been fun..

I am not patient with excuses.."well, we send coding to a contractor"..nope, ain't my problem, don't want to hear it..I just don't know how elderly people navigate the system..don't even get me started on in network and out of network..and don't even ask about medical condition..I haven't time to even think about what this poor man is going through..all can do is give best care, and make sure we don't go into bankruptcy...because of some ones error..!!!!

Moral of story..watch the coding, group ID, name of ins on member card, and make sure they match..also, if you do have an ins. co in/network requirement..verify Dr. ofc uses in-network anesthetist ..HUGE!! thank you for all you do Aristus..

[area51]

4. We desperately need single-payer,

and get the insurance cos. out of the mix. jmho.