Thrifty Thinking: How To Avoid The Hassles of Insurance Based Medical & Pharmaceutical Prior Approval

Houston based neurologist Dr. Steven Goldstein knows all too well the difficulties and needless expenses patients can endure while waiting for or negotiating with their insurance carriers for so called ‘prior approval’ for prescribed medicine or treatments. Dr. Goldstein has examples to share and advice for people who want to save money, time and manage their own treatment regardless of the policies of insurance companies. He shares these with his listeners on his weekly podcast that can be heard on the Houston Health Initiative website (www.HoustonHealthInitiative.org) Soundcloud, iTunes and many other on line sites that can be seen here:http://houstonhealthcareinitiative.libsyn.com/prior-approval-script-what-to-expect-from-houston-health-initiative-co-op.

What Is Prior Approval?

Prior approval is a way that insurance companies decide on how or whether a prescribed medical service, medication, test or procedure meets their coverage criteria. “It is a way that insurance companies decide on how or whether a prescribed medical service, medication, test or procedure meets their coverage criteria,” Dr. Goldstein said. “They review your medical record using an algorithm that is filled out by a medical assistant. If this fits the guideline, fine. If not the medical office, asks the doctor for a different diagnosis to use or asks the doctor to answer questions from the algorithm.”

Paperwork Delays and Expense

Many physicians contract with a third party to do this work so as not to overburden secretaries in the doctor’s office or the doctor.  If the test or procedure is turned down, the insurance companies have hired physicians to discuss the case with the treating physician on appeal. These costs are passed on to the patient in the form of higher premiums. “All this takes time and the patient must wait before a test or procedure can be scheduled,” Dr. Goldstein concluded.

About Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) is a member owned, non-profit medical co-op. Led by Houston based neurologist Dr. Steven Goldstein, the HHI (http://houstonhealthcareinitiative.org) will replace traditional health insurance for qualified individuals and families and provide incentives for members to adopt healthier lifestyle habits. Details about qualifying for membership in HHI along with prices for coverage are available from the HHI web site at http://houstonhealthcareinitiative.org.