I called AMI yesterday to get a prior authorization for a brain MRI with and without contrast.
This is for a woman under 65 who is having short term memory problems. We are looking for treatable causes of short term memory loss. The blood work is negative. Next is the MRI.
Her MRI is already scheduled at the local hospital where I worked for nine years. It is the only hospital because we are a small county.
The AMI representative suggested that the patient get the MRI in Everett.
"The cost there is $917.00. It would be cheaper. It is only 29 miles away."
"Yes, but Everett is across the sound. She'd have to drive around or take a ferry. What is the cost in Bremerton?" I asked. "At the radiology providers there?"
"The cost there is $967.00."
"And where she is scheduled?" My local hospital has a "Rural Hospital" designation. Medicare will pay them more than other hospitals.
I squeaked. "For the same MRI?"
"Um. You should tell the patient." Except that, is the patient willing to drive to Bremerton? And is the cost to the patient the same? And do they care?
"Do you want the prior authorization for that site."
"Can it be changed if I talk to the patient?"
"Yes, she can call us."
The prior authorizations are now site specific. That is, I'm getting approval for the MRI at a specific place. I have no idea why.* Seems stupid. Seems like just another hoop to remember to jump through and if we get it wrong the insurance can say, "Oh, ha, ha, ha, we don't have to pay for that. You do." Chalk up some more profit for the investors. Mission accomplished, money made.
I called the woman and explained. She was willing to go to Bremerton and said that she would call AMI. I asked her to call us back if she had any trouble.
The cost really matters to my medicare patients and any patient that has to pay a percentage of the cost. If they only have medicare part B, with no secondary, they pay 20% of the bill. 20% of 4500.00 is a lot more than 20% of $900. But some of my frailest most elderly most confused don't really have a choice. Going 29 miles might as well be going to the moon.
And this is a woman with memory loss, remember? She wrote down the instructions and repeated them back to me three times.
Every phone call to insurance is like this, and makes me wonder about our culture.
* Actually, the authorizations are site specific because some places are "out of network" and the insurance won't cover anything done there. Though I think the whole point of health insurance in the US is to try to remove money from people and avoid paying for care.