Quote:
Originally Posted by snafu
Currently you have an insurance clerk decide which procedures you deserve and which shall be denied.
|
This is really an oversimplification of the current system.
Yes, a non-clinical person answers the phone or receives the fax requesting authorization for a test, procedure or medication. But that person evaluates the request based on a set of criteria established by a group including medical personnel. If a request is denied, the requesting physician can appeal and have the case reviewed or can pick up the phone and call the medical director, a physician working for the insurance company, and explain why the test/drug is needed. I've done that many times and only on a handful of occasions in my 17 years of practice has my request ever been denied.
The problem is that doctors shouldn't have to jump through hoops like that in order to get their patients the care they need.
How do things work in the countries you mentioned (England, Australia, Sweden and Canada)? There must be some system in place to certify care. Otherwise, costs couldn't be controlled. Does anyone know how authorizations, drug formularies and such are handled in any of those places?