MONTHs ago, I saw a young patient who lost all her hair one day. And as someone who developed alopecia areata ophiasis and lost all her eyebrows and hairlines, I KNOW I needed to act fast. So far, this is the despicable game we have been asked to play with coordinated care: - I tried “traditional” therapies with steroids, injections, etc. Failed (of course). - I prescribed a Biologics that’s FDA approved for alopecia areata for patients over 12, and documented (heartbreaking) photos, and detailed reasoning why we needed the medication - Insurance denied it. (#1) - I appealed, got denial #2. - I requested peer to peer discussion and blocked my busy clinic time to do it. - A non-physician called my nursing staff and REFUSED to talk to me and denied my demand to talk to a peer, so even my peer to peer was denied! (#3) - Told us we needed an exception application. I put together a 38 page letter including the FDA approval and clinical trials and my notes, again. - We didn’t hear back for weeks. - Then we got denial #4 because we “didn’t file the right appeal.” - I filed yet ANOTHER appeal. - We’ve not heard back again for weeks now. We keep calling and be put on hold for 30 minutes at a time. Here is what prior authorizations do: - they aim to drive cost down for insurance companies, and serves as few patients as possible - they waste clinicians’ time for patient care - they waste nursing staff’s time for patient care - they hurt patients by dictating what happens in the exam rooms without actually being there 👏Prior 👏 Authorizations 👏 Are 👏SCAMS 👏 and 👏 they 👏 harm 👏 patients 👏 You know what I’m going to do? I’m going to get my patient the FUCKING medicine. 🤬 zedzha.com/blog/hide-away…
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@DrZedZha We have been fighting #priorauthorizations too! @NYCMayor chose to force us into #medicare #disadvantage plans and we sued to stop them. @TWULocal100 forced their retirees into it & now we wait for oral arguments to get Justice. This is criminal. Healthcare is a human right