An Insider’s Recipe To Navigating Your Prior Authorization
The death of UnitedHealthcare’s CEO has reignited backlash against health insurance practices, particularly prior authorization rules. This episode explores the parallels between today’s outrage and the late 1990s backlash. Archelle sits down with Dr. Lee Newcomer, a fellow former Chief Medical Officer at UnitedHealthcare during that era, to share their unique insights. Together, they examine the pros and cons of prior authorization policies and discuss the urgent need for reforms to enhance access to medical care and restore public trust in the healthcare system.
Key Takeaways: A Recipe for Navigating Your Prior Authorization
Step 1: Have 5-7 days of patience.
Step 2: After 5-7 days, call your doctor’s and verify that the prior authorization was submitted. Make sure all the info is correct.
Step 3: Call customer service and ask for the status of the request. If they don’t have an answer, get a commitment on when they will follow up. Mention your intention to contact the Attorney General’s Office
Step 4: Escalate if there is no follow up within the time promised. Options (you can do all 3)
· Call the Health Insurance Company CEO and request a referral to the Expedited Appeal Unit
· Contact the Human Resources Department of your employer
· Submit a complaint to the Attorney General’s office in your state. Here’s a link for the AG in each state: https://projects.propublica.org/claimfile/
Don’t Forget:
Keep your calm and be rationale. You’ll get more accomplished that way.
If your doctor believes that the medical test or procedure you need is urgent or emergent….don’t wait for the prior authorization. Get the medical care you need and if its denied, you can appeal it later.
Links:
Attorney General Offices in each state State: https://projects.propublica.org/claimfile/
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