Wherein we ponder vexing issues in infection prevention and control, inside and outside the hospital.
Unfortunately, this video is so true. A few days ago I called an insurance company to get preauthorization for a CT scan on one of my patients. I called the number on the patient’s insurance card and pressed the number for radiology preauthorizations. After several more stops in the phone tree, I finally reach a human. I give him all the information, including information that I had previously keyed into the phone, and he ultimately tells me the patient does not need preauthorization. So I’m happy that I can now call radiology scheduling to get the test scheduled. But then he says, “just because he doesn’t need preauthorization doesn’t mean he doesn’t need preauthorization.” Huh??? After multiple attempts at an explanation, I finally learn that I wasn’t actually talking to the patient’s insurance company, even though the initial automated phone message said it was the insurance company. Along the phone tree, I had been transferred to a company to which the insurance company outsources their radiology preauthorizations. However, the insurance company (not just the outsourced company) also requires a pre-authorization. So he instructed me to call the same 1-800 number and to this time not push the key for radiology authorizations so that I could talk to a person from the insurance company. Ultimately I reach a human at the insurance company. She wants my tax ID number, which I don’t know, since it’s the tax ID number for the entire physician group practice of the medical center. She offers no other solution. I finally ask, “can’t you use my NPI number?”, and she responds, “ok, I’ll use your NPI number.” She asks what procedure I am seeking preauthorization for and I tell her. She then asks, “what’s the CPT code for that CT scan?” I tell her I don’t know. After a long silence I ask whether she has a list of CPT codes for radiology procedures. She informs me that she does but unless I can tell her the CPT code she can’t tell me whether the patient needs preauthorization. I then embark on a google search trying to find the CPT code for the CT scan I need. I ultimately find the CPT code and give it to her. She then informs me that my patient does not require preauthorization.This farce consumed 35 minutes of my time and is a great example of how we allow insurance companies to ration health care and how dysfunctional the US healthcare system has become.
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