Do frequent authorizations really save money?


I've written before about how my health insurance improved when my family moved to California from Louisiana. Upon our move, my husband and I enjoyed $11 acupuncture visits every week, greatly benefiting both of our health and wellness. After previously paying $80 to see my favorite acupuncturist, suddenly finding myself with such an inexpensive copay was welcome news to me.

Unfortunately, the tide has turned yet again. Although we still have stellar coverage, my husband's company made some changes to our benefits this year when it switched us to a high-deductible plan that requires the family spend $2,000 before coverage really kicks in.

One of the biggest changes for us is we now have to obtain prior authorization for acupuncture services. The kicker here is each authorization is for only four sessions. So our acupuncturist has to reach out to our insurer about once a month (since we generally get treatment once a week).

What's more, before we can even receive authorization, my husband and I had to visit our acupuncturist for a special "assessment," in which she was supposed to determine whether we need acupuncture services and if she can help us. We might not even be reimbursed for the price of that visit.

This new system places a huge burden on our acupuncturist, or any other provider deemed to offer "specialty health services," because now they have to make phone calls and do paperwork on their patients' behalf several times a year. And it potentially creates lag times between consumers needing services and providers being able to offer them.

Like many other employers, my husband's company is likely trying to reduce costs with this switch to a high-deductible plan that requires frequent authorization requirements. I understand that. But it certainly doesn't engender good relations with its networked providers, who already spend too much of their time on paperwork instead of actual patient care.

Payers and providers have got to work together in this ever-changing, post-reform market. A similar move to what my insurer took could easily alienate many providers, compelling them not to renew their contracts. I wouldn't greet additional busywork with open arms and renewed relationships.

Discouraging regular, systematic use of preventive services, such as acupuncture, is definitely one way to reduce costs. But is it really worth it in the end?

Acupuncture and other alternative services can help payers avoid additional costs in the long run because they prevent health issues from becoming full blown and chronic, which are some of the biggest drivers of rising healthcare costs.  

So by trying to hinder its members from seeking out acupuncture treatment, my insurance company might actually cost itself more money. Imagine how many of its members will stop going to an acupuncturist because of the hassle to obtain authorization. If just a few of those members could have healed injuries or eased conditions through acupuncture, for example, the insurer would have avoided paying for pricey medications, screenings and testings or even surgeries--all likely outcomes of traditional medicine.

I hope insurers can find new and innovative ways to save money while still covering alternative treatments so everyone in the healthcare system can benefit. - Dina (@HealthPayer)