Washington E-Newsletter

Neurosurgeon Featured in Article about Prior Authorization

On Nov. 1, Becker’s Orthopedic Review published an article titled, “UnitedHealthcare’s prior authorization removals just ‘payer antics,’ surgeons say.” While UnitedHealthcare has eliminated several spine surgery services from prior authorization, surgeons have not seen any real benefit from the removal. California neurosurgeon Brian R. Gantwerker, MD, FAANS, notes:

I have not seen any changes regarding prior authorization elimination. If anything, I imagine it is a ploy to try to muddy the waters. Hospitals and physicians have experienced terrible amounts of denials and unfair withholding of payments and clawbacks. I imagine that there is a new, more sinister technique that they will use in order to get around the prior authorization bills coming through Congress, and this is just a poorly spirited attempt. The next phase of payer antics I’ve seen is prepayment reviews, which technically get around the prior authorization process by having physicians perform the service after getting prior authorization, but then denying payment after the service has been completed. This obviously provides some window to get around privatization laws and “be compliant.” Until the Office of Inspector General and the Federal Trade Commission enforce existing laws around insurance companies, we will never see improvement.