If you live in the United States of America then you know that sometimes it feels like health insurance is a scam. You pay lots of money every month for them to deny things you need or only cover a small portion of it. But it’s not just insurance users that have to jump through hoops lit aflame to get the insurance company to approve something, it’s doctors too.
Recently a Doctor Peter, MD, donned a blonde surfer style wig and his best California surfer accent to reenact his first time having to call in a prior authorization. A prior authorization is often needed when a doctor prescribes a medication that the insurance company deems unnecessary. No, the insurance companies are not doctors nor are they the patient needing the medication but they have a list of approved medications they’re willing to cover. If the medication you’re prescribed isn’t on their list, it sets of a frustrating chain of events.
The doctor opens the video by saying, “today was my first prior auth and last,” before diving into the hurdles that is prior authorization. He explains he was working in an emergent situation and needed medication for his pediatric patient, which required him putting the prescription into the computer system. That’s where things quickly go downhill.
“Then the pharmacy calls me and says ‘hello’ I say ‘howdy do.’ They said ‘your medicine needs a PA.’ I said, ‘well I have three of them sitting next to me should I send one down,'” he recalls.
Of course at this point the doctor is assuming for some reason the pharmacy in the hospital needed a physicians assistant to help them. That’s when Dr. Peter learned about prior authorizations. After learning he had to contact the insurance company to authorize the medication he confusingly says he authorized it when he hit enter on the computer. One would think a doctor ordering the medication would be enough to authorize it, but Dr. Peter quickly found out that his prescription meant little.
@doctor.disney This should be illegal #kids #doctor #parents #teacher #nurse
Though the doctor delivered the message with humor, the entire situation is frustratingly familiar to patients and medical professionals alike.
“We should be able to bill the insurance company when we have to complete a prior authorization for our time,” one person writes.
“Every year the insurance company makes me get a PA for *insulin* for my son who is a *type 1 diabetic* as though he’s been magically cured,” someone says.
“I am *enchanted* with your storytelling. I’m deeply *disenchanted* by the American health system,” a commenter writes.
Dr. Peter’s reenactment is amusing but his video is also informative showing others what people have to go through to get the medication they need.