Insurance company denial causes woman to lose leg, hip, and pelvis.
Ms. Valentini saw an orthopedic surgeon for excruciating hip pain. An x-ray did not reveal the cause of the pain, so the surgeon ordered an MRI. Her insurance company, Group Health Inc. (GHI), denied the request. When the MRI was finally approved, the MRI found a sarcoma. Due to the delay, she required extensive surgery to amputate her leg, hip, and pelvis. She died two years later. Kathleen Valentini's family has brought a lawsuit against her insurer, claiming their denial lead to her death.
The article Insurer Delays Prior Authorization points out that Ms. Valentini's experience is just one of countless cases where prior authorizations have led to severe delays in patient care.
A survey conducted by the American Medical Association (AMA) found that 93% of physicians report delays in care due to prior authorizations. Physicians said that prior authorizations led to patients forgoing care and, in some cases, to serious adverse outcomes.
Office practices need a well-designed results management process to ensure diagnostic tests are completed and the practice receives results. Medical Mutual's practice tip Results Management: Tracking Diagnostic Tests and Referrals will help you evaluate and improve your test tracking process.