Independence is the freedom from dependence on or control by another person, organization, or state. Unfortunately today physicians and patients have lost their independence. Physicians are now controlled by hospital administration, government policies, and insurance companies. Patients are dependent on their insurance company. This lack of independence has placed a great strain on how medical care is given in the United States of America. First Dayton Cancer Care is fighting for the right to practice medicine in a way that is best for our patients, not someone’s bottom line.
INSURANCE PRIOR AUTHORIZATIONS
Any person with insurance who has tried to have a procedure should know the term prior-authorization. This is where the patient and the physician must ask the insurance carrier permission to give treatment. This authorization is solely based on the ‘plan’ that patient has contracted and the formulary that insurance carrier has established for the diagnosis and the treatment requested. They can deny authorization regardless of what the physician feels is the best medical choice. This authorization can take up to 30 days; if initially denied, the entire process can take 60 days. And if authorization is given, there is no guarantee of payment.
The Ohio State Medical Association (OSMA) and First Dayton’s practice manager have spent the past year fighting for Ohio Senate Bill 129 which would regulate how carriers handle prior authorizations. While not every agenda item was approved, we will see an improvement in this process over the next two years. The two key items that will affect the patient the most are more timely decisions and payment for authorized procedures and medications.
Insurance carriers now must give authorization in a timelier manner. For urgent care services consideration must be given within 48 hours of initial request and within 10 calendar days for non-urgent care. This will allow the patient and the physician to move forward with treatment quicker so that a patient is not anxiously waiting to begin very important treatments like that for cancer.
If prior authorization was given, insurers will no longer be able to retroactively deny payment for a claim. This is excellent news for patients and physicians. It basically means that insurers must do what they promise and pay for what they should.
We hope that this change to the authorization process will help patients and physicians alike. Physicians have the training and experience to make the decisions for that individual patient. The doctor to patient relationship is so important to quality health care. We must continue to fight insurance carriers and the government from dismissing the importance of this relationship. The beauty of medicine is treating the entire person not simply the disease on paper. This can only be accomplished when a physician is able to get to know this individual person and work together for their health.
First Dayton stays independent of the hospital systems so that our patients maintain their right to choose the best radiation therapy available today and we will continue to fight insurance carriers for this choice.