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Preauthorizations – a cautionary tale

October 23, 2022 am31 11:02 am

Does Medicare Advantage really hurt? Are preauthorizations really that bad? Read on:

Barry, a recently retired software executive, tells a cautionary tale.

When a gastric issue led the 65-year-old (his name has been changed to protect his privacy) to the hospital this summer, a CT and biopsy revealed pancreatic cancer. His oncologist came to his bedside to discuss next steps.

“We’ll need to do a PET scan to see if the tumor is localized, and that will determine whether we should do chemo or surgery,” he was told. With pancreatic cancer, the oncologist said, “the faster we move, the better.”

But the oncologist frowned. Unfortunately, the scan couldn’t be scheduled for 3 or 4 weeks.

“You’re the Cleveland Clinic,” Barry responded.

“We’re not the problem,” the oncologist replied. “We have to get approval from your insurance. We’ll submit it, they’ll reject it. There’s a lot of back and forth.”

Barry was puzzled. …

“Just to be clear,” he said, “I’m not in Medicare Advantage. I have regular Medicare with a supplemental.”

The oncologist’s “whole demeanor changed.” … The frown became a smile.

“Well then, we can go a lot faster,” he was told.

He got his PET study 3 days later. Barry said a 4-week wait would be intolerable. More importantly, he said, “The sooner I could begin, the less chance the tumor would have to grow or spread elsewhere and become much more difficult to treat.”


In other words, health care delayed is health care denied.

This story is from MedPageToday (no paywall, but registration required) – not a hotbed of radicalism. But you don’t have to be radical to be 65 or over. And if that’s you, or if that’s about to be you, the idea of getting blocked from care is frightening.

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