Prior Authorization: The Insurance Denial System Blocking Your Treatment #CareTalk
With Miranda Yaver, author of "Coverage Denied"
Every year, tens of millions of Americans are denied the medical care they’ve already paid for - not by their doctors, but by their insurers. Miranda Yaver the author of the new book Coverage Denied, explains how insurers use “rationing by inconvenience”, and what patients, advocates, and policymakers can do to fight back in this #CareTalk episode with myself of Health Care Voices.
Get the book: https://amzn.to/4uCmN6z
Also Louise Norris of healthinsurance.org and Diane Archer of Just Care answer your health insurance questions on Medicare, Medicaid, the Affordable Care Act, private insurance and more.
Free or Low Cost Health Care Resources on our show page: https://healthcarevoices.org/caretalk
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I’ll never forget the time I did a PA for a pt, who met the insurance company’s (very reasonable) criteria for an expensive drug. It was denied. I appealed and it was denied again. I spoke to someone on the phone, explained that the pt met the criteria — got nowhere. I was about to give up, but I called the medical director, explained the case, & he approved it. I thanked him & hung up, but wondered if I should have asked him why I needed to call him to get the clearance…
A lot of the time the people who are making the decisions about which patient gets a given service is not even a doctor, let alone a doctor who specializes in that particular disease. It is sometimes some pencil pusher who is looking at the costs over whether the patient will be helped. That is really callous!