Letter: Payer offers biased perspective on prior authorizations

August 19, 2014

A physician disagrees with the views of an insurance company spokesman regarding the need for prior authorizations.

In a recent edition of Medical Economics, you quote Edmund Pezalla, MD, of Aetna Inc. in a discussion regarding prior authorizations ("Prior authorizations: A payer's perspective," July 10, 2014).

He tells us that “until fairly recently most medical care was based on intuition and  guesswork.” I did not realize that I have been blundering in the dark for the last 20 years.

He also states that “we’re trying to make sure this is the right thing for the patient.” To think I imagined  that was my task. Clearly, patients need to be protected from my misguided ways.

The remainder of his remarks suggest that most physicians requests are for unusual or unproven tests. Ninety-nine percent of my applications are for CT [computerized tomography] or MRI [magnetic resonance imaging] scans, and precious few of these.

Apparently profit has no motive whatsoever in prior authorizations. 

I stand enlightened.

Russell Lee-Wood, MD
Barnesville, Ohio