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03/04/2013    Keith L. Gurnick, DPM

RE: Pre-Authorization for Imaging (Bill Weis, DPM)

Here is how I currently handle this situation.
On any patient where I order imaging done
outside my office, I inform the patient that
they must phone their insurance company before
scheduling the test to find out if a pre-
authorization or pre-certification is required.


Also they are instructed to get the name of the
person whom they spoke with. If pre-
authorization is not required, they are to
schedule the test. If, however, a pre-
authorization is required, the patient is then
required to obtain the phone number so that we
can speak with the insurance representative
to obtain such authorization before the test is
scheduled.


Either way it is documented in the record for
possible future reference. When
authorizations are required, I have my office
staff make the phone call and give all the
routine information (patient name, date of
birth, insurance ID numbers) to whom ever they
speak with. I only come to the phone when
necessary to answer any medical questions or
give the required clinical information if and
when it is above what my secretary can answer
from the medical record.


I estimate that 90% of the time, my request
(MRI, bone scan, CT, etc) is authorized by a
non-doctor however when the patient's
clinical information does not fall within the
insurance companies spec sheet of standard
guidelines, I get passed forward to a
radiologist who almost always "grants" me the
authorization after telling my story, including
why I need the test and what I have already
done.


Like the other doctors who chimed in on this
issue, I find this to be a big waste of my time
however I try to participate in these calls when
I am sitting at my desk doing other work like
charting, billing or eating lunch. Private
practice is so much fun.


Keith L. Gurnick, DPM, Los Angeles, CA,
keithgrnk@aol.com


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