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Topic: Back problems

A day in the life of a primary care physician: prior authorizations, denials, & delays in treatment

 

For Profit HealthcareThe national debate on health reform has uncovered innumerable “health care horror stories” in which cancer patients worry more about their bills than their malignancy or where pregnant women are laid off and dropped from their insurance soon before their due date.  These stories are tragic, and unconscionable for the richest country in the world, however, as a physician, this is not my typical experience.  Instead, what I see every day is patients with private health insurance who cannot afford the copays for their medications, delays in treatment as I grovel for prior authorization with a non-physician utilization reviewer, and patients stuck with huge bills for routine services that they thought they were covered for.

In my practice, patients have a mix of private and public coverage.  While I work with some extremely impoverished patients who qualify for public insurance through Medicaid, it is the people with employee sponsored private insurance who are most at risk for roadblocks to care.  As a primary care physician, it is hard enough to fit all of the recommended screening, health education, and chronic disease management that complex patients need into a fifteen minute visit.  When the burden of battling with insurance companies is added to the equation, there is no way that I can succeed.  My patients, especially the ones with private insurance, are forced to deal with the high copays, denials of claims, and delays in care. «Read the rest of this article»

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