re: The Prior Authorization Process for Medicine

Authorizations are yet another modality used by insurance companies to prolong needed care (read: less spending for them within a given period of time) and it creates more hurdles for clinicians and patients to overcome.

Many HMO plans require authorizations through the PCP for a mere office visit with a specialist....even if you've already been established with that doctor. Meaning, in order to keep seeing your specialist who has been treating you for months or years, the clinic staff at your specialist's office has to submit a formal "authorization request" to your PCP for your next visit. Your PCP's clinical staff then has to submit the claim to the insurance company, and then work with the insurance company to obtain an auth/claim number, and then they have to submit that information back to the specialist's office...all just for one single 10 minute office visit. It's just an absolutely absurd system.

Authorizations, co-pays, co-insurance, etc. Every few years health insurance companies layer on additional checks and balances into the system that creates headaches for everyone involved...except for themselves.