06/24/2025
This is huge news!! I really hope to see some reform. This is a voluntary change through pressure from RFK and HHS. The major insurance carriers will make getting treatments like medicine and surgery simpler and more streamlined. This is a real problem that my patients and I deal with on a daily basis. Insurance carriers routinely put up arbitrary roadblocks requiring patients and/or providers to jump through hoops in order to approve acre. These roadblocks are then dealt with through an appeal process that further slows things down. I have to wait and get on the phone with a nurse or non-urologist to explain why care is indicated (imagine having your healthcare decisions coming down from someone who doesn't even practice in the field). Oftentimes, they just didn't even read my notes that include all the information they required. Afterwards, no apology for wasting everyone's time, just a "here is your authorization number, goodbye." They do this intentionally in the hope that someone doesn't pursue the claim appeal process and they get out of paying for services. Horrible!! All of the major carriers seem to be onboard with implementing this change except for one glaring absence.... . They are the most notorious for pulling this s**t. They go as far as to tell us that no Prior Authorization is required for surgery, then after the surgery send the patient a bill saying that the "pre- authorization process is not a grantee of payment"! Well how are patients supposed to know if their surgery is covered or not? This type of corrupt insurance behavior is exactly what is wrong with private healthcare and needs to stop immediately! I'm looking forward to see how these changes are implemented and their effect. This is definitely a step in the right direction and much overdue.
