From: Judd Davis, DPM
Dr. Pearl posted a video about doctors' offices having to obtain a pre-determination in order for insurance to cover a hospital admission for a serious and potentially limb-threatening infection. In my 20 years of practice, I have never had to do that. Maybe the insurances he works with are different, but I think most hospitals have administrative staff on hand who contact the insurance companies immediately upon admission to get those authorizations in place.
Hospitals have a very vested interest to make sure the admission services are covered or they lose out hugely. When a badly infected patient shows up at my office, we arrange a direct admit through the hospitalist team so the patient can avoid hours in the ER and the huge bill that comes along with the ER visit. This saves the insurance company and patient a lot of money and time.
Similarly, for things like MRIs and CTs, my office does not do any pre-authorizing for those. The imaging center that is providing the MRI and profiting from it should have staff to do that work. My staff only pre-auths surgeries and orthotics, that's it. In these times of declining reimbursements and increased bureaucracy, we all need to minimize these headaches as much as possible.
Judd Davis, DPM, Colorado Springs, CO
