Banner
  • Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

Second Opinions: Englewood Family Health Center

Article

The challenge: Health plans deny or require pre-authorization for prescriptions of name-brand drugs.

ENGLEWOOD FAMILY HEALTH CENTER ENGLEWOOD, NEW JERSEY

THE CHALLENGE:

Latorre estimates that for every denial, he and his staff spend more than an hour haggling with insurers and completing paperwork, not to mention fielding calls from angry patients who wonder why they can't obtain the medicine their doctor says they need. Each denial ends up costing him about $95 in time and phone bills, he says.

Latorre sometimes provides samples that he gets from pharmaceutical reps, but those only go so far. In the meantime, he's been prescribing only generics, which leaves him unsatisfied.

"I feel I am not really giving the best of my work to my patients," he says.

THE SOLUTION:

There's no easy solution when a doctor tries to challenge the protocols insurers have developed, warns David C. Scroggins, CHBC, a practice management consultant with Clayton L. Scroggins Associates in Cincinnati, Ohio.

Latorre and similarly vexed doctors can try to appeal insurers' denials, but that's time-consuming and counterproductive, Scroggins says, so doctors should carefully consider which cases are worth fighting and pursue only a select few.

Latorre's best bet-for reducing patients' ire at his practice, at least-may lie in getting patients to understand why the drugs he thinks are best for them are getting denied. Perhaps that will open patients' eyes and inspire them to seek out more comprehensive insurance, Scroggins says.

"Remember, the patients are the ones who have purchased their health insurance policies, and this experience will give them insight into the quality of their policies, so perhaps they will upgrade in the future."

Need a Second Opinion of your own? Send your questions and comments to meletters@advanstar.com
.

Related Videos
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health