Hey guys, this is Dr. Lam, I'm gonna show you how ridiculous this whole authorization
process is for the insurance company to get a CT scan. I ordered a CT scan for a patient and
now they're asking for prior authorization, so obviously the insurance company tells
the patient that it is our fault for not calling to get this simple authorization,
so let's do this live. I'm dialing the number that they gave me for the rejection,
obviously they have not read my note, because my note tells them exactly why I need it.
Welcome to United Healthcare.
Please try again.
Well, it's asking for my NPI now, the ten digits.
Entered that in for them. Now they want the phone number that they used for my request.
Asking me for a fax number to communicate with me for this request.
Now it's requesting for the patient ID number from their insurance card.
Now it's asking for patient date of birth.
Now they want the patient's information -- home telephone number, this is all so that I can get
a patient a CT scan, even though I wrote the order and the notes justifying why we need to get it done.
Well, now I actually have a tone.
Pressing 1 for a CT scan.
Again telling me it's a CT scan, still haven't spoken to a live person yet.
Now they're transferring a call to complete my cases.
Hi, I'm calling to get a prior authorization for a patient to get a CT scan done,
Yeah, Kevin Lam, initial is KL.
I am the doctor.
That is correct.
That is correct, without contrast.
That is correct,.
Yes, you want to verify the phone number -- two three nine four three zero three six six eight,
FAX number is two three nine six nine two nine four three six.
Okay, there's only one case I'm asking for and it got denied
so it's telling me I have to call back and get an authorization.
Correct, okay so I'm trying to get that approved.
Okay go ahead with the series of questions, go ahead.
Okay, so what do I have to get out of the hold status and into approved status?
Okay.
Yes, go ahead connect me to peer to peer.
It's Kevin Lam.
I am.
That is the correct patient you just said.
That is correct.
I'm in wrong department? Okay thank you.
Need a peer to peer apparently, that's what they told me.
Let me write this down, case number now.
Well it's been close to ten minutes already and after a one minute wait I have not spoken to anyone yet,
they're putting me to departments to departments.
Still waiting.
Of course at this time I wrote the order for the patient, I'm not seeing any patients,
I'm sitting here waiting.
This is Kevin Lam.
I am the physician.
Oh that's it, I just need the authorization number now,
that'd be awesome, did they authorize both of them?
Oh no, it's the same one, but bilateral,
did they approve bilateral? or did they just approve one side?
Now the original order is written for both sides, they have to order for both sides and
now it's a surprise that I need it for the other side. They were only gonna authorize the one
side when the patient has a problem on both. So here we go still waiting, they're building
a case from scratch, again hopefully -- luckily they didn't have me call again.
Gosh, guess what, 15 minutes in we are still waiting.
I think this process to be more of an annoyance or deterrent for the doctor to order the necessary
tests for the patient. But unfortunately we have to get it done for the patient's own good or else
they'll tell the patient that your doctors just did not get the authorization just by calling this
number, we had all the time. So here you go, I'm just calling this number for ONE of my patients
I'll see what my office staff's up to, someone's speaking in my ear, I couldn't do very much so
let me give them a message right now.
Raymond I know you spoke a whole paragraph to me before but I'm on the phone
getting an authorization, can you please send me an IM of what you're trying to tell me or
ask me please, IM me secure, IM me because I'm on the phone.
Message is for Ray, tell Ray to send me an instant message of what he was trying to tell me
'cause I'm on the phone and I cannot hear his whole message,
just insta message me the message.
Maybe almost 25 -- at best you will get this at a half an hour just to get CT scan for my patient.
So this is the "one simple call" that your doctor has to make to get your scan done.
It says peer-to-peer but it's not a physician on the other line.
Do not bother me I am on the phone for prior authorization.
Still waiting.
So they're opening a case for the other side even though my order is for BOTH sides,
so luckily I got to the end and the lady said she was gonna give me an authorization but
I asked if it was for both sides and she only confirmed only one.
So she's going back and having them do two - I don't know why they only did one but here we are.
Imagine doing this for every patient we have to see that needs an authorization for a CT scan,
there's got to be a better way.
Or imaging study -- that means this goes for ultrasound, MRI, or CT
I was so excited I clicked off on the -- right after I hung up.
Well in summation, got the approval for both sides, only took about 20 minutes plus
to get it done, did not speak to a doctor, I don't know why they had to get me on this phone
for 25 minutes but it was approved,
maybe they should have looked at the documents I sent over the first time,
but now is going putting this authorization number in the patient chart
having my front desk call the patient and getting in the tests now.
Ordered this test about a week ago, so patients probably think that the doctor is slacking
which is what they tell the patient -- your doctor has not called for the authorization
even though I ordered the test.
Where are the days when your doctor just ordered a test and it's because you need it?
Now we have to go through the prior authorization department -- peer to peer,
not even peer to peer anymore,
not even a physician on the other line.
So well hopefully you guys enjoyed this,
I'll go ahead and get my patient in, thank you.