While UnitedHealthcare has recently taken steps to remove several orthopedic and spine codes from its list of procedures requiring prior authorization, surgeons are not necessarily seeing positive outcomes from code removals.
Issada Thongtrangan, MD, a spine surgeon at Microspine in Scottsdale, Ariz., told Becker's that even for orthopedic and spine codes that have allegedly been removed from prior authorization requirements, insurers are still sticking physicians with a hefty bill post-procedure.
Dr. Thongtrangan: I have not noticed any changes from the reduction of prior authorizations, at least at my practice. I get the worst experiences from "no authorization required" procedures from the insurance companies many times. One example was a patient who had left sciatica symptoms. He failed non-surgical measures for at least one year. He met all the criteria and guidelines for surgery. His insurance said no authorization was required for the surgery, a microdiscectomy. Three months later, the insurance refused to pay for the service because they said the surgery was not medically necessary.
Even in the case of a patient who was pre-approved or pre-authorized by insurance for cervical disc arthroplasty, their insurance later refused to cover the implant for a reason that was so comical: "We approved the surgery, but did not approve the implant."
"No authorization required" could put the practices in real trouble because the insurance companies will use their tactics to deny the service later on. I feel strongly that the insurance companies are doing everything in their power to make everything so miserable for the physicians, and the ultimate goal is to make the most profit possible. They can be careless about their "clients," which are our patients.