Everything was good to go. Documented everything I need to document to prove it needed to be done. She had exhausted every non-operative option available. Should be covered by insurance with a prior authorization right? Oh dang... nope. Insurance decided they don't want to pay for it after the surgery. How much was the surgery? Well turns out it was over $42,000. And before anyone says that it's surgeon greed... my total reimbursement I receive for this case is $683.20.

So then what happens? Well the patient has to fight to try and get them to pay for it. They try everything to get out of it. Despite my notes clearly stating it was a medical necessity and she had exhausted all other options I had to write another letter to confirm this. Then they wanted a peer to peer which they currently are not willing to schedule as they "analyze the data". What's the harm then right? Well... it's been over 3 months. With a $42,000 bill sitting over this lady's head. She cannot pay that. It will destroy her. On top of that she is afraid to tell me how well the surgery is working for her because she is afraid if I document any issues they will say "see we don't need to pay for it." Which would not happen, but how do you tell a patient to trust you when she is already being screwed by the medical system?

All for a surgery that was prior authorized. I'll do whatever I can to get rid of that bill for her, but to sit here and act like insurance companies have the patient's or health care system's best interest in mind is absurd. It is only about the bottom dollar. Their entire goal is to NOT pay for something. That is all they are looking for. I bristle when people come at me defending insurance companies. All it tells me is they either work in insurance or are not actually a practicing physician that has to deal with the nightmare that is insurance on a regular basis.

I wish that was my only story of such abuse. I wish it was my only story this calendar year of prior authorization being an issue afterwards still.