STAT April 26, 2024
It’s another busy day in my spine surgery clinic when my phone rings. Patients are waiting, but I’d be unwise to put off the caller: a physician calling from a health insurance company. This peer-to-peer call is part of the prior authorization process; my “peer” needs information to determine whether the company will cover a procedure I requested for one of my patients.
Sometimes the conversation goes uneventfully. The “peer” and I establish that the service is medically necessary, and it quickly gets approved. But it usually feels like talking to a wall — a distant voice reading scripted questions off a computer screen — and I sense this is a box-checking exercise destined to result in a predetermined denial....
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