Doctors here in Michigan are asking Michigan lawmakers to do something about the insurance companies now demanding pre-approval of what they say are routine low cost procedures.

The Detroit News is reporting that these new cost-controls are creating unnecessary red tape and increasing cost to the physicians' offices.

These prior authorization where created so doctors and other providers get pre-approval from a patient’s insurance company to cover their prescription drugs, procedures, equipment and tests. 

They then ask for what is called step therapy, or “fail first”.  These require a patient to try cheaper medicines before advancing to a more expensive drug.

According to the Detroit News the bill would:

The bill would make insurers post their prior authorization requirements on their website, including statistics regarding approvals and denials, and give providers 60 days’ notice of new requirements. The rules would have to be based on peer-reviewed clinical data and input from actively practicing physicians, and “adverse determinations” could only be made by a doctor who is in the same specialty as the patient’s physician.

Also, insurers would be required to act on authorization requests within 48 hours – 24 for urgent ones. Doctors could override a step therapy if they consider it to be in the patient’s best interest because the drug likely would cause an adverse reaction, is expected to be ineffective or the patient had tried it already under a previous insurer.

I certainly understand their frustration, their concerns are all legitimate.

Here is my concern, what do they and everyone else who supports government single payer healthcare i.e. Medicare for all, think is going to happen when you get our government bureaucracy involved.

The biggest criticism of single payer healthcare systems already in place around the world, including Canada, is the need for pre-approval of almost all non-routine procedures and long wait lines to get those procedures done.  That is why people who have the money in those countries come to the United States to have their medical procedures performed.  They say the wait time is quite a bit less and the doctors are much better here in the United States.

Wait until the government gets its red tape on that system and you can kiss that all good bye.

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