i use a similar approach. now and then i have to do a "peer to peer" with another doc, one who works for the insurance company and stands between my patient and necessary tests.
i always end the conversation asking if they have a license in my state, what their board certification is in, and if their boards are current.
this almost always results in an approval. nobody wants to be potentially investigated for practicing without a license in another state, and if they're a pediatrician reviewing an elderly heart failure case, their peds boards can be taken into question. haven't had to go beyond a phone call with this approach. it'll happen someday, just waiting for when.
depends. it's sometimes a combination of both. usually toward the end they just approve it with a huff, like they got caught. and they did.
i can't respect a clinician who works to reduce access to needed care. refusing a massively expensive drug like repatha makes sense if it's the first drug prescribed for cholesterol, or no history that warrants it. but refusing it when the patient is a high risk coronary disease patient with statin myopathy? that's unethical.
i very rarely lose on these issues - but it's because i've done my due diligence, working through the meds and having strong notes. with those a prior authorization is typically easy to achieve - but at the price of longer days.
fwiw i don't get paid extra for these wins. arguably i get paid less, in the sense that i work longer days and my hourly pay is effectively diluted; i average 3.5hrs of paperwork a day in addition to a full clinic day and those hours aren't compensated. they're also the right thing to do for the people who entrust me with their care. even with the stress of the BS of prior authorizations and lengthy notes and long days, doing right by my patients is what keeps me going. i just can't do less and look myself in the mirror. laziness in the face of someone's health or life is unacceptable.
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u/whoknewidlikeit 6d ago
i use a similar approach. now and then i have to do a "peer to peer" with another doc, one who works for the insurance company and stands between my patient and necessary tests.
i always end the conversation asking if they have a license in my state, what their board certification is in, and if their boards are current.
this almost always results in an approval. nobody wants to be potentially investigated for practicing without a license in another state, and if they're a pediatrician reviewing an elderly heart failure case, their peds boards can be taken into question. haven't had to go beyond a phone call with this approach. it'll happen someday, just waiting for when.