Getting prior approval is becoming meaningless

Mindy D · ‎05-23-2010

This article discusses a trend in which insurance companies are granting prior approval for tests and procedures and then reneging on their approval after treatments and test results come in. Patients are left with huge surprise medical bills. One patient was approved for tests and treatments for transverse myelitis but when testing results showed she had beriberi the insurance company then withheld payment leading to bankrupcy for her and the loss of her home. New approvals are coming with a statement from insurers in legalese that allows the insurance company to escape from the approvals. There’s much more in this article. https://khn.org/news/prior-authorization-revoked-patients-stuck-with-bills-after-insurers-dont-pay-a...

Snooky60 · ‎11-14-2017

@Mindy D That you for posting this information. Something very important for us to think about. Yikes! 💗

SeaMaiden · ‎03-10-2010

Frightening 🙁

ValuSkr · ‎03-15-2014

The situation described - retrospective denial - must be a nightmare for those involved. Thank you shining a light on it. We can only hope the AMA, if not our legislators, addresses it. Our healthcare system - while highly profitable for some - is a mess in so many ways.

Kachina624 · ‎03-10-2010

I've never heard of this practice but it sounds like pressure needs to be put on state insurance regulators to crack down on it. Forget the feds; now they're all for big business.

New Mexico☀️Land Of Enchantment

chrystaltree · ‎05-10-2010

Most patients know nothing about this because the hospitals are the ones who are affected the most. The hospitals are losing the money. The article got it right, I know because this is my world, the world I work in. I work with doctors and patient finance to obtain authorizations that will not result in lost money when the insurers do their retro reviews. Still, the hospital I work for loses millions because the game is rigged. Every authorization from every insurer and Medicare specifies "authorization is not a guarantee of payment" and they can do those retro reviews up to two years after payment. The hospital I work for does not bill the patient for money they must return after a retro review audit so patients never know that the $40,000 they think the insurer paid the hospital a year ago when they were admitted was retracted and the hospital got $0 payment. Why? Because upon admission physicians thought the patient had a heart attack but after admission and tests, it was determined the patient was suffering from acute chest pain, cause unknow. The authorization was for heart attack so, the insurer retracts payment. Years ago, hospitals could appeal a denial like that and produce documentation showing that the patient had all the signs of a heart attack and only after tests did we know he hadn't had one. But! Insurers play hardball now. They don't allow appeals this type of denial, they just take they money back. No, it's not something that any insurance commission can help with. No, it's not something a hospital can sue an insurer for. The right to do retro reviews is in the contracts hospitals have with insurers. But that's a story for another day.

quilter61 · ‎03-22-2010

I also saw this article on CBS News about the state of Kansas jailing people with unpaid medical bills. Here is the link:

The health system really needs fixed.

NicksmomESQ · ‎08-19-2014

That's nuts!! But I've heard through some people I know in the medical field that insurance companies are catching on to many doctors over diagnosing & treating.That's why they are doing this.But it's not right .Nor is it fair to the many patients that pay for health insurance.

There has got to be a better way. Doctors should get paid & patients shouldn't be stuck with the bill. Insurance companies must be forced to live up to their obligations, period.

It's amazing to me that a country as advanced & wealthy as ours can't figure out a way to provide it's tax paying citizens with affordable healthcare!!

millieshops · ‎03-09-2010

Once again Walter Kronkite and his team had it right. Among the many wise observations I remember him making was that anyone wanting to die with money in reserve for their final days and maybe even some left for their heirs needs to wish for good health all the way to the end.

I'm with @Kachina624 - write and call your state representatives.

50Mickey · ‎05-21-2010

@quilter61 wrote:
I also saw this article on CBS News about the state of Kansas jailing people with unpaid medical bills. Here is the link:

https://www.cbsnews.com/news/coffeyville-kansas-medical-debt-county-in-rural-kansas-is-jailing-peopl...

The health system really needs fixed.

I read the article. They were not jailed for owning a medical debt. They were arrested for contempt of court for failing to appear in court twice about said bill. Not a smart thing to do.