[Warning: saga follows} I guess I have been one of the few served by HPSO through the last 10 years. First a sole practitioner, then an agency owner-operator who utilized contractors ( contactors were required to have insurance and submit a Dec page annually) plus my own liability coverage. It was high, that agency + myself. Last year, I got a te…[Read more]

Thanks for the post and article. This hits home for me. I am a pharmacist and was a part of the Prior Authorization “crap show” for almost a decade (worked for numerous plans, various high level positions, etc.). VERY disturbing. I could write a book on the issues. I was eventually let go for doing what is best for the patient. I would not be a…[Read more]

Disgusting!

Agree, it’s SICK care!

I use a local insurance broker to source the best policies as far as coverage needed and cost. Doing the leg work and trying to translate all the jargon was just too much for me, especially on an annual basis. When I receive the renewal notice each year, my broker reviews it against rates for other plans and lets me know whether a change would be…[Read more]

Hi Gabrielle,
I would look into hospice care at home. End stage liver disease is definitely a qualifying diagnosis. That might free the friend up from medical responsibility and will allow the patient to have a good quality of life with two terminal diagnoses. Sad case. Hope this helps.

Anthony Douglas, MD

Thank you all so much. I am having a little imposter syndrome. This is only my second client.
Update:
She is off the hold. She is going to go to an Acute Rehab for her injuries. Now the sending and receiving facility has mentioned that they need more “manpower” to transport her and it is different because of her psyche. I know from experience…[Read more]

I have had clients in psych wards who were admitted on an involuntary basis and later transferred to another facility, but it requires that they agree to it voluntarily. Of course, this only makes sense if the physical needs of the client can be met at the transfer facility.

The issue of which side of the hospital (behavioral health vs medical…[Read more]

Katy,

Thank you for your reply. Yes, it can be a bit much navigating multiple insurers, especially when the re-application process requires a re-do every year of the intensive initial application, it is time-consuming.

Dena,

Thank you. I had looked at the APHA page that lists insurers, but I wasn’t sure if it was current information. The minimum rates listed for those insurers are much higher than my current rate (unlesss it goes up!), but I will reach out to them and see what they say. I may reach out to you and Deb in the future if I have more questions.…[Read more]

I agree with Gail. I have not had any 5250 cases as most of mine are adolescents, but I would think that the hold is the legal justification for involuntary hospitalization and obviously psychiatric transfers are common. I don’t think they are removing the legal hold. The only issue I would foresee is if the hold is issued in a particular…[Read more]

Great comments above! Here’s another illustration: One of my clients received a ‘prior auth’ for an EP study and possible ICD implantation. Following up, I learned that he would be considered Out Of Network, (though that was never communicated), and would have to pay $120,000.00 out of pocket before the procedure!

Hello Katy,
Typically any time there is a facility to facility transfer, it is done via a licensed ambulance company so that the chain of custody can be documented and maintained. If the current facility has a 5250 hold, then I would think they cannot remove that hold. Perhaps they meant “remove” the hold from their facility standpoint, but she…[Read more]

You’ve heard this from me too many times before: Health care isn’t about health OR care. It’s about sickness and money.

Thanks for sharing that article Linda. I see a tactic that advocates can put into good use when their client is against a wall.

It can be devastating for our clients. Great Article! I have a client who went for a simple outpatient hernia repair. The facility went through One Note Link and the CPT code with that insurance company came back “no prior authorization needed” never flagged the facility as out of network. The facility even gave him a Cost Estimate citing the…[Read more]

Hello,
I went with Don Mucci from the Apha listing. I am insured by the Hartford and Lloyds of London.
I really wish there was just one instead of having 2 different companies for different parts. Next year I will see what Hiscox quote would be.
I initially reached out to NSO where I get my RN malpractice insurance. It was not expensive. They…[Read more]