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Re: Another can of worms

In a message dated 97-08-17 19:16:19 EDT,  (Michael
Sachs) writes:

> 	Do any of the managed care companies have a FAX authorization option for
>  non-emergency referrals.
 [. . .]
>  	I also saw the suggestion by Bill Braun which was very good.  You might
>  also see if there are any procedures they would consider allowing you to
>  order without any authorization, period.  My IPA removed plain-film X-Rays
>  from the authorization category after it was determined that 99% of the
>  requests by all the provders in the group were appropriate and the process
>  of authorizing plain films became a waste of everybody's time.
>
Thanks for the suggestions--some are already done.  Some companies do have
fax authorization, and some let us write the referrals without company
authorization.  One (United) doesn't require any authorization or any
paperwork--it's wonderful!  Also, some have specialty networks that do not
require any authorization.  Florida just passed legislation allowing patients
to see dermatologists without referrals for any managed care.  It has to be a
provider on their list, but they do not need referral or pre-authorization.
 If you need your appendix removed, you need authorization, but not for warts
or acne!  A lot of our time is also spent verifying insurance coverage.  The
insurers all recommend doing this each time the patient is seen (unless it's
a capitation plan, and you've gotten your list for that month already).
 We've been burned, so we do check, but it sure takes a while sometimes.  Now
some companies have fax or automated phone verification which speeds things
up a lot.  Hopefully more will follow that lead.

Moshe Adler, MD