Pre-authorization programs require doctors of chiropractic to obtain approval to treat a patient. Cumbersome forms must be completed that are often several pages long and may grant one patient visit. Delays in needed treatment and increases in the cost of claim administration are unwelcome results. With the attention to rising premiums, insurers need to look at ways to streamline claim- handling operations, rather than adding to the cost of insurance by imposing unnecessary claim delays. Patient treatment windows are too narrow to allow for a patient response.
Care is denied at two visits at times without an explanation or a reasonable means to appeal.
Many appeal programs are an exercise in climbing through a barbed wire fence. Maintenance care definitions prevent patients from obtaining supportive care for a chronic condition and acute care for an exacerbation of an existing condition. Maintenance restrictions are not applied to MDs who treat chronic diabetic or hypertension patients on a regular basis. Medical review personnel are unavailable or inaccessible to discuss discrepancies with the treating provider and all too often cannot provide the rationale for their decision-making or identify the actual sources for their determination. Automated programs sold by vendors are used as the sole basis for determination.