Local doctor unhappy with insurance pre-authorization process

Local doctors and nurses agree the process to get insurance pre-authorization for care is a growing problem. They think companies take too long to approve necessary medical tests, procedures and medicine for their patients.

Posted: Feb. 7, 2018 10:58 PM

TERRE HAUTE, Ind. (WTHI) - Local doctors and nurses agree the process to get insurance pre-authorization for care is a growing problem. They think companies take too long to approve necessary medical tests, procedures and medicine for their patients.

One Terre Haute doctors says he got into medicine to help people but his job is getting harder because insurance companies will take days to approve his treatment plans. However, legislators could create a cure at the statehouse.

Doctor Robert Haerr is a Radiation Oncologist at Hux Cancer Center in Terre Haute.

"It's not just a problem in Terre Haute. It's a problem in the whole state. It's a problem in most states."

Everyday, Dr. Haerr says he and a team of nurses work with insurance companies. They have to get many of the more expensive tests and procedures pre-authorized. Dr. Haerr says that's reasonable but the time it takes companies to respond is not.

"The person may need a CT scan and we're looking to see, do they have cancer that's spread to their brain but their insurance company says, well it's going to take six days to decide whether they can do it or not."

Dr. Haerr says his treatment plans are almost always approved but it still takes days for answers and a lot of time on the phone.

Registered Nurse Donna Price says, "You can count on forty-five minutes to an hour each time you make a phone call."

Nurse Price and Dr. Haerr say the people on the other end of these calls do not have a clinical background.

Price says, "The first person you come in contact, usually is the person who has a script of questions that they're asking and a lot of times they want a yes or no answer to questions that aren't yes or no questions."

Haerr says, "Often time the person on the other line is a high school student who can't even pronounce the medical terms correctly."

Sometimes Dr. Haerr has to get on the phone with an insurance company doctor for treatments to get approved but it can take days before that happens.

If care is not approved, Haerr says the appeal process can take up to thirty days. In his experience, he says he only knows of three times a treatment plan was ultimately not approved.

To keep patients from waiting for the care they need, Dr. Haerr says he will begin treatment before getting it approved. This can be scary for patients because they do not know if they will have to cover the bill. The hospital also risks not getting paid.

"I know the insurance company is going to say yes so why do they have to wait six days? That doesn't make any sense."

Dr. Haerr and Nurse Price are encouraging people to contact their state leaders about Senate Bill 210 and House Bill 1143. The bills would make insurance companies move faster through the pre-authorization process.

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