Our AMA needs to help its members. The council's report was based on an online survey of physicians. The denials had big impacts on practices, the survey indicated. Doctors also reported the denials led them to attempt to bill patients and lose staff time. Pediatricians and ob-gyns were most often told that the service was not covered, while for psychiatrists and surgeons, the most frequent reason for claims denial was a lack of prior authorization.
Anesthesiologists seem to be hit particularly hard by claim denials.
Some at the meeting questioned whether the numbers truly reflected the experiences of physicians. Ronald Davis, MD, a delegate from the American College of Preventive Medicine, wondered about the low response rate in the survey, as well as how representative the respondents were. Those who have had problems would be more likely to respond than those who didn't. The delegates also reaffirmed a policy stating that the AMA supported both legislation and regulations to prevent the retrospective denial of payment for any claim for services for which a physician has gotten preauthorization, barring any fraud or the provision of any incorrect information when the approval was obtained. Back to top.