When Past is Prologue
Some doctors admit they simply are not ready to trust the health plan based on past experience.
"What it boils down to is that we get penalized so severely if we don't verify benefits and pre-authorize services that we still basically have to do this," said Bohn Allen, MD, a surgeon in Arlington, Tex. Although he finds United easier to deal with than other plans, "It still is not a situation where we see the patient, do what we need to do and then file a claim," he said.
Resolving misunderstandings with physicians remains a challenge, acknowledged Texas medical director Dr. Hawkins. "I understand their fear, because with every other plan they're dealing with, that is very real," he said. However, he repeatedly tells physicians they will not be denied reimbursement for covered care that was not pre-authorized. Physicians who call in for unnecessary pre-certifications are faxed a list of those procedures that still require notification, he said.
Some of United's changes do represent an industry trend toward a more narrowly focused use of pre-authorizations, said Susan Pisano, spokesperson for the American Assn. of Health Plans. Managed care organizations introduced pre-certification to reduce variations in medical practice, she said. In those areas of medicine with less variation, where established practice guidelines are generally followed, health plans are moving away from the costly and time-consuming ritual of pre-authorization, she said.
Despite unpublished industry data supporting that view, physicians say they see little evidence that the managed care industry is undergoing any major change.
"We're not seeing any big concrete steps so far from the other carriers," said Rich Johnson, director of medical economics for the Texas Medical Assn. He credits United, however, for mapping out a strategy that "has real possibilities."
Medscape Neurology. 2000;1(1) © 2000 Medscape
Cite this: United's New Approach: Good PR or Better Patient Care? - Medscape - May 22, 2000.