One of the most important Capitol Hill initiatives around health care is House Energy and Commerce Committee Ranking Member Frank Pallone’s ongoing investigation into aggressive prior authorization used by health insurance companies.
Despicable behavior by the managed care organizations who - want to "build a healthier world," "help people live healthier lives," "improve health, well-being, and peace of mind," and are "dedicated to improving lives and communities." Does anyone in the real world believe these statements from Aetna, UnitedHealthcare, CIGNA, or Elevance respectively?
Evan, you've hit the nail on the head. Why would for-profit insurers care about our most vulnerable communities, who would most benefit from preventative care?
Politicians (in this case at the state and not federal level - though they are basically one in the same) took their problem and made it a for profit problem their cronies could “solve” where the cronies get rich and the problems never get solved. US healthcare system is broken.
Absolutely unconscionable that insurance companies managing the Medicaid programs for children are instituting prior authorization. What a shame these private insurance companies have inserted themselves into every aspect of American Healthcare, it’s literally killing us!
United Healthcare took over Healthplex in NY state. They offer different types of plans, including many of the medicaid/essential plans people purchase through the NY state portal (the "Obamacare" plans). We were in network with those medicaid/essential plans with Healthplex. Healthplex never asked for preauthorization. We routinely had our usual procedures covered without issue. Once United Healthcare took over, that all changed and we started getting rejections for failure to get preauthorization. No one disputed that the procedures were necessary and covered. The only dispute is that we didn't get a preauth ahead of time. United Healthcare won't even tell us when preauthorization is needed and when it isn't! We cannot get anything in writing from them and get a different answer each time we call. So, we have taken to preauthorizing everything. This delays care, which isn't vital for what we typically do. If it is vital, then I will just do the procedure accepting the fact that I likely won't get paid for it. For non-vital services where the patient doesn't want to wait for preauth, I considered having the patient pay and then get reimbursed once (if?) we get the insurance to pay. Turns out that because I am in network I am not allowed to do this. The patient has to either wait for United Healthcare to preauth, which they do about 99% of the time, or go out of network and pay someone entirely out of pocket since there are no out of network benefits for these medicaid/essential plans. I used to think that insurance demanding preauths and delaying payment was a way for them to earn interest on the monies they hold. Now I think the end goal is to drive the patient out of network so they don't have to pay at all. It's a total scam.
Despicable behavior by the managed care organizations who - want to "build a healthier world," "help people live healthier lives," "improve health, well-being, and peace of mind," and are "dedicated to improving lives and communities." Does anyone in the real world believe these statements from Aetna, UnitedHealthcare, CIGNA, or Elevance respectively?
Evan, you've hit the nail on the head. Why would for-profit insurers care about our most vulnerable communities, who would most benefit from preventative care?
Politicians (in this case at the state and not federal level - though they are basically one in the same) took their problem and made it a for profit problem their cronies could “solve” where the cronies get rich and the problems never get solved. US healthcare system is broken.
Absolutely unconscionable that insurance companies managing the Medicaid programs for children are instituting prior authorization. What a shame these private insurance companies have inserted themselves into every aspect of American Healthcare, it’s literally killing us!
They don’t even want to give children school lunches much less health care access.
And they claim to be christians! “Jesus wept”🌈
United Healthcare took over Healthplex in NY state. They offer different types of plans, including many of the medicaid/essential plans people purchase through the NY state portal (the "Obamacare" plans). We were in network with those medicaid/essential plans with Healthplex. Healthplex never asked for preauthorization. We routinely had our usual procedures covered without issue. Once United Healthcare took over, that all changed and we started getting rejections for failure to get preauthorization. No one disputed that the procedures were necessary and covered. The only dispute is that we didn't get a preauth ahead of time. United Healthcare won't even tell us when preauthorization is needed and when it isn't! We cannot get anything in writing from them and get a different answer each time we call. So, we have taken to preauthorizing everything. This delays care, which isn't vital for what we typically do. If it is vital, then I will just do the procedure accepting the fact that I likely won't get paid for it. For non-vital services where the patient doesn't want to wait for preauth, I considered having the patient pay and then get reimbursed once (if?) we get the insurance to pay. Turns out that because I am in network I am not allowed to do this. The patient has to either wait for United Healthcare to preauth, which they do about 99% of the time, or go out of network and pay someone entirely out of pocket since there are no out of network benefits for these medicaid/essential plans. I used to think that insurance demanding preauths and delaying payment was a way for them to earn interest on the monies they hold. Now I think the end goal is to drive the patient out of network so they don't have to pay at all. It's a total scam.