Prior authorization continues to delay patient care and treatment, impact outcomes, and drive up health care costs for all Hoosiers. Physician offices advocate for their patients but are forced to waste valuable time and resources on these burdens.
Your stories about how prior authorization impacts patients are a powerful way to help ISMA put
Patients Over Prior Auth.
Please participate in ISMA’s advocacy initiative by sending us the latest example(s) of payors inappropriately putting prior auth over patients. More than 110 stories have already been submitted to ISMA since the short intake form went live earlier this year.
There is no limit on the number of submissions you can make. In fact, the more examples we have, the more impactful it will be -- even if they are repetitive.
Andrew Skinner, MD, shared, “I am the medical director at an inpatient facility that provides acute detox for substance use disorders. A teenage patient came in reporting daily use of 60 mg of illicitly obtained methadone and injecting fentanyl along with that on a daily basis. Also regular IV methamphetamine use. The patient had a previous history of failure with outpatient treatment with buprenorphine via Sublocade. The patient was admitted for opioid detox. The patient’s entire stay was denied by Anthem HIP, saying they did not meet the criteria for inpatient detox. We are in the midst of the fentanyl epidemic. Anybody with basic familiarity with substance use disorders understands that if we turned this patient away, they are almost certain to continue using. This is literally THE MOST LETHAL CONDITION for patients in this age group! It is their leading cause of death. Adding in daily doses of methadone only serves to greatly increase the risk of fatal overdose."
Visit
www.ismanet.org/PatientsOverPriorAuth to share your story and read several others.
Please consider sharing this article with your colleagues, even if
they’re not ISMA members. We want to hear from as many Hoosier physicians as
possible.
Thank you for continuing to advocate for the well-being of all Hoosiers. Your participation in this
Patients Over Prior Auth initiative will help bring about vital change.
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