Two recent articles outline the growing difficulty in communications between insurance companies and physicians. Many patients ask me why they can’t have surgery tomorrow. It is a difficult position as a specialist in that patients come in today and want surgery tomorrow. While we may have just met for the first time today, they have been dealing with their pain and issues for months or years. The decision was a long time in the making, and once the decision is made, they are ready. This is understandable to all of us involved in the care of a patient, but not necessarily to their insurance company. These articles outline the difficulties that primary care physicians have in getting medications approved. We have similar, if not worse, issues with getting surgery approved. Some highlights from the first article:
- The administrator for Medicare and Medicaid estimated that needless administrative complexity led to $107-389 billion in wasteful spending in 2011
- 7% of all claims are paid incorrectly by insurance companies, costing providers $43 billion
- The average physician spends 3 weeks per year dealing with insurance companies (and therefore not taking care of patients)
- 23 weeks of nursing staff time and 44 weeks of clerical staff time are spent on insurance claims
- Physicians spend 45% of their workday outside of a patient’s room
- In 2012, there was a 23% increase in claims requiring preauthorization, adding $728 million in administrative costs (while at the same time the reimbursement to physicians was decreased)
The only people that the insurance companies listen to are (1) federal agencies, (2) state agencies, and (3) their insured patients. We have found that in many instances the patients are able to get approval and authorization much faster or more easily than we are due to the insurance company’s interest in seeing their insured patients be happy. Nearly every procedure that requires an overnight stay in spine surgery requires preauthorization. If you or a loved one is preparing for surgery, encourage them to contact their insurance company to help get the authorization expedited! We love taking care of our patients and enjoy seeing them overcome their illnesses and disabilities while getting back to the lives they want to live!