Prior authorization started out as a means by the “payers” of health care goods and services to provide patients the assurance that what their doctors order is medically necessary and appropriate.
And these companies are all practicing medicine without a medical license. The quickest way to get approval for something is to ask for the NPI of the doctor practicing medicine. They can't give it, because it doesn't exist.
I wish it were this easy. In actuality, any denial issued is done by a specific doctor licensed in the appropriate jurisdiction for the given patient. The name of the responsible party is made available at any time for accountability. The bigger issue is that they can rightfully deny cases with impunity for administrative reasons or violating the letter rather than the spirit of the law. They exist to force referring doctors to prove they really care enough to do the work necessary to get procedures completed.
Love this: "We can tell clients who provide insurance that we denied 15% of the requests that came in the door last year, and if we cut out 15% of your costs on certain claims, it would save you $2 per member per month. Well, we're only going to charge you 50 cents per member per month — what a bargain! "
Andrew Tobias wrote a book on the entire insurance industry decades ago called "The Invisible Bankers." In it, he suggests every insurance policy have a disclaimer saying, "This insurance policy, on average, pays XX cents on the dollar to buyers of the policy."
Prof. Mariana Mazzucato points out the difference between Value Extraction and Value Creation in the video linked below. Clearly this is Value Extraction with no added value creation!
In a talk titled "We Need To Question The Economic Stories We've Been Told," economist Mariana Mazzucato discusses the importance of examining the concept of value in economics and how it is created and extracted. She argues that without a clear understanding of value creation, we risk allowing value extraction to masquerade as value creation, leading to a distorted perception of productivity and value in the economy. Mazzucato suggests that we need to consider what areas of the economy are productive and unproductive in order to steer activities towards value creation, and calls for a rethinking of how we measure productivity and value in different sectors.
And these companies are all practicing medicine without a medical license. The quickest way to get approval for something is to ask for the NPI of the doctor practicing medicine. They can't give it, because it doesn't exist.
I wish it were this easy. In actuality, any denial issued is done by a specific doctor licensed in the appropriate jurisdiction for the given patient. The name of the responsible party is made available at any time for accountability. The bigger issue is that they can rightfully deny cases with impunity for administrative reasons or violating the letter rather than the spirit of the law. They exist to force referring doctors to prove they really care enough to do the work necessary to get procedures completed.
Love this: "We can tell clients who provide insurance that we denied 15% of the requests that came in the door last year, and if we cut out 15% of your costs on certain claims, it would save you $2 per member per month. Well, we're only going to charge you 50 cents per member per month — what a bargain! "
Andrew Tobias wrote a book on the entire insurance industry decades ago called "The Invisible Bankers." In it, he suggests every insurance policy have a disclaimer saying, "This insurance policy, on average, pays XX cents on the dollar to buyers of the policy."
It's still a great idea!
Prof. Mariana Mazzucato points out the difference between Value Extraction and Value Creation in the video linked below. Clearly this is Value Extraction with no added value creation!
Here’s the video link: https://www.youtube.com/watch?v=J7ZSWcDWLnI
Here’s the Chat GPT summary.
In a talk titled "We Need To Question The Economic Stories We've Been Told," economist Mariana Mazzucato discusses the importance of examining the concept of value in economics and how it is created and extracted. She argues that without a clear understanding of value creation, we risk allowing value extraction to masquerade as value creation, leading to a distorted perception of productivity and value in the economy. Mazzucato suggests that we need to consider what areas of the economy are productive and unproductive in order to steer activities towards value creation, and calls for a rethinking of how we measure productivity and value in different sectors.