DR. HOOK- Ask first: Singing the pre-authorization blues

Close your eyes. If you're still reading this, your eyes aren't closed. 

Okay, now really close your eyes and imagine a world that has insurance for absolutely everything. You name it, it's paid through insurance: toilet paper to cable TV. You cannot purchase anything, sell anything, or do business transactions without using insurance. (This is beginning to sound worse than the Amityville Horror.)

Let's say you work in a grocery store. All your floors are shined, the cereal boxes are perfectly lined up on the aisles, and the aroma of bread floats from the bakery. Everything's perfect. You open your doors, and within 30 minutes, all your checkout aisles are filled– over flowing– bursting at the seams with angry customers. Why? They're waiting for your cashiers to process their grocery insurance.

For example: Ms. Quaker wants to buy a new oatmeal brand, but her insurance gets back to you, "Please fill out the following pre-authorization form." 

You pull out your pen, fill out Ms. Quaker's name, address, date of birth, and insurance card information. You then have to find out how long she's been eating oatmeal, what brands– and on what dates she ate these oatmeal brands. Does she use the oatmeal for making cookies?

Hmmm, you aren't sure of her history, so you ask Ms. Quaker these questions. She doesn't know, doesn't have her old receipts for her oatmeal purchases, and she doesn't remember why she switched brands in the past. Pre-authorization request: denied. No sale.

Now say you're a florist. Your customer has a big wedding– bigger than any Greek wedding could possibly be. She chose her red roses six months ago, but now she's on her fiancé's new florist insurance. So she tells you that you have to get pre-authorization on the red roses. Ugh. You just pricked your finger on a thorn, and now you have to call the flower insurance, be put on hold for about 45 minutes while listening to bad Kenny G elevator music, and then talk to the insurance person who sounds like she hasn't changed out of her pajamas since 1975.

You get the faxed pre-authorization form with the typical questions. Now to the meat of the form, "Has she ever used yellow roses, or white roses with the tips sprayed with red paint?" If so, when did she make these purchases and what were the outcomes? (Please include surveys of her guests on their satisfaction with these prior roses.) Pre-authorization request: denied. No sale. 

Wouldn't you hate to do all that work on pre-authorization to satisfy the customer and then be denied? If so, welcome to the wonderful world of USA healthcare. Recently a Medicare Part D vendor, Humana, again asked me to do the 1 millionth pre-authorization request– this time on a generic asthma inhaler that has been available since the birth of Christ. Yes, the patient can pay for it since it's cheap, but patients want insurance to cover everything as much as possible. 

Once I had a person ask for pre-authorization on a $6 medicine to get it for $3. Little do people know it can take hours to do a single pre-authorization because of being put on hold with the insurance company, filling out the forms, and doing research on the dates of use for previous medicine as well as copying labs and tests that have been done. 

I wonder if there's insurance to cover insanity caused by insurance? The problem with that is pre-authorization would be needed, and an incapacitated person can't possibly get the pre-authorization through. Plus what's the point of doing all that work to get a rubber stamp, "Pre-authorization request: denied!" 

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions. 


1 comment

This article is so true. Things are really getting crazy in this world. Pretty soon we will need pre auth for everything. I have been on both ends of the pre auth process, from working in a doctor's office, to now doing billing. Insurance companies have really gotten picky. Pretty soon to deal with anyone you will only be able to do it by the auto line or on the website. If there was coverage for insanity I think all of us could use a little help every now and then. God Bless all of the Medical Secretaries,Hospital Billers, and yes even the Small practice doctors, my hat is off to all of us. Have a great weekend.