We are hearing about more and more pre-authorizations for prescribed and recommended medical procedures being denied. Almost all of these denials that we are hearing about are emanating from the large carriers like United Healthcare, Blue Cross, etc. We received an article titled, “Blue Cross Blue Shield put patient through ‘prior authorization hell’ over infusions.” As long as groups continue to give these carriers total control over their medical lives, these types of problems will continue to take place.
Denials such as the one cited in the article are commonplace amongst these large carriers already. However, when the group controls their claims reserves and engages an independent claims administrator and independent stop loss carrier, these barriers are minimized. This is another example and reason as to why employers of all types have to become serious about finding alternative methods of providing health insurance to their staff.
The attached article share more insight into this subject.
– Howard Danzig, President of The ECCHIC Group