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Services Performed Without An Office Visit

In 2018, Insurance companies allow physician offices to bill for non-face-to-face work performed on behalf of the patient. This includes prior authorizations, form completions, coordination with pharmacies regarding medications, referrals to other providers, after hours work performed by the physician. We have previously performed these for free but now insurance companies have recognized the value of physician and staff work for these administrative tasks. These tasks could last from 35 to over 75 cumulative minutes depending on the nature of the task and whether the physician and/or my staff spend time on the phone for these tasks. Patients have the option of coming in for a full visit and would we urge patients to move up appointments.. As a convenience if this is performed you would not need to come in for a full appointment.

Why?  Services performed outside of an office visit require time on the part of staff and physician.  What seems like a simple request to the patient, is really more complex than it seems and may take cumulative time over one or more days to accomplish and involve not only the physician but staff as well. 

Insurance plans are implementing disincentives for patients to receive medications which are not “preferred” or generic, or even entire classes of drugs.  To maintain the medication a patient has been taking or to begin a new medication, we may be expected to complete paperwork called a "prior authorization" to get the prescription approved - even if the patient has been taking the medication for a long time - so that it will be covered on some level or change your medication to one that is "preferred” or generic.  Generally we do not find out that a prior authorization is needed until we receive a notification from the pharmacy.  Insurance companies review and approve medications at the beginning of each year.  Thus, the status of medications changes from year to year and from plan to plan.  Prior authorizations require chart review, medication review, documentation to the insurance company, and frequently follow-up phone calls that end up taking 30 to 40 minutes, much of that time on hold.  Then the insurance company will review the data sent to make their determination.  Their process can take up to 3 business days.

Change in insurance plans further complicates the picture when one plan covered a medication with no issue, but the new plan has a different formulary or a different mail order pharmacy.  If we do not have the new plan information, because it has not been provided or updated in the patient portal, the renewal can become further complicated and increases the time to complete the request.

Referrals to specialists require the physician to review the problem, select the best Specialist for the problem, and issue the referral.  Some insurance companies will require that we authorize a number of visits, anticipated procedure to be performed, etc.

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