Doctors needs uniform standards for insurance “pre-authorizations” that delay medical care | PennLive Editorial

If you’re seriously ill and depending upon a competent doctor to keep you alive, the last thing you want is an insurance company getting in the way.

But doctors with the Pennsylvania Orthopaedic Society say that’s exactly what’s happening in Pennsylvania and other states that allow insurance companies to interfere with doctors prescribing what’s good for the patients under their care. For too many insurance companies, it’s all about the Benjamins, the doctors say, and not about ensuring the best care for people facing major health care decisions.

The stories are horrifying. Dr. Paul Juliano, President of the Pennsylvania Orthopaedic Society, told of one woman who found herself stuck between her doctor’s advice and her insurance company asking for other less expensive treatments to be tried first. That’s called “fail first.” Everything cheaper must fail before the insurance company will pay for what the doctor ordered in the first place.

In this poor woman’s case, all the cheaper options failed. She wound up with permanent damage to her bladder. God only knows what her life is like now.

Juliano has story after story of cases like this where doctors fought insurance companies to do what’s best for their patients. Now, they’re asking the state legislature for take up the fight.

Juliano joined Dr. Suzette Song, a member of the board of the Pennsylvania Orthopaedic Society; and Dr. Asif Ilyas, past president, for a recent meeting with PennLive’s Editorial Board to garner support for passage of Senate Bill 225 now before the legislature. The bill would set uniform standards for insurance companies to demand “pre-authorization” for medical treatment. Plus, it would set timelines by which insurance companies have to respond.

Both demands are reasonable and potentially lifesaving for thousands of Pennsylvanians.

Too many patients with serious illnesses are left in limbo while insurance companies dither over whether there might be a cheaper treatment, the doctors argue. And too often, we’re not talking about experimental or innovative treatments, they say. The insurance companies are dithering over routine and established medical protocols that can have lasting health repercussions, like bladder damage.

Sen. Kristin Phillips-Hill (R-York) is leading the charge, the doctors say, but she needs public support. Legislators need to know these issues matters to voters. They need to hear from people who could find themselves waiting for an insurance company to let the doctor do his work. As it is now, insurance companies have no set rules for when they can demand preauthorization and how long they can delay medical treatment.

This is an issue that could affect anyone just when they’re too ill to fight. You don’t want to find yourself quibbling with an insurance company when your doctor says it’s time to operate. We need clear, uniform standards set into law in Pennsylvania.

We need doctors, hospitals and Big Pharma to set reasonable fees. And then, we need insurance companies to get out of their way.

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