Dr. Emily’s Story

I have a patient who is post op from a cesarean section. She had a complication of a wound abscess. She was hospitalized and  had interventional radiology procedures to treat the abscess. 

She is two weeks out from that complication. She return to clinic with concerns of a new infection around her incision. She was seen in our office. Given her previous abscess that required drainage via a procedure, I wanted to get another CT scan of her pelvis. We ordered the scan through our outpatient radiology clinic in our hospital (where she had previous imaging). 

The insurance company required a prior authorization. They sent us to another service they use to help them with prior authorization. They said it could take 3-5 days. 

My option was to have her just do it and risk it not being a covered benefit or send her to the Emergency Room and get it that way, which is way more expensive to the patient and the system. 

I also am very upset as a practitioner because the insurance company is completely disregarding my clinical knowledge and having actually been involved in this patients care for the last 9 months of her pregnancy and postpartum course. So incredibly frustrating and poor patient care and increasing cost the system and complete disregard for my medical training and knowledge. Maybe computers and insurance companies should just take care of patients. Never mind the time it took me and my clinic staff in addition to adding her on to our already busy schedule.