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167 points ceejayoz | 1 comments | | HN request time: 0.202s | source
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raincom ◴[] No.43665574[source]
Insurers have another weapon: Insurer's preferred telehealth provider is the only one who can process PA(prior authorization). If your PCP prescribes an expensive prescription, PBM(say, optum Rx, owned by UHC) will tell ur pharmacy to have the prescriber get a prior authorization. When your PCP tries to get a prior authorization, insurer will say "the insured party should go through a telehealth provider for treatment". Now that telehealth provider creates more hurdles for patients. For instance, UHC uses Transcarent/join9am.

Insurers will add more and more indirections instead of outright denial. First indirection: get a prior authorization(PA). Second indirection: only a particular telehealth provider has the authority to ask for a prior authorization--and this is a new trend. Expect more layers of indirections.

I understand that healthcare costs are exorbitantly high. The people who have the power to control these costs are politicians, super wealthy, and the elites (lawyers, executives) serving the super wealthy. The latter groups get the care they want without any hurdles. Others just pay all insurance premiums, only to find that they are denied care when they need the most.

replies(1): >>43665822 #
1. potato3732842 ◴[] No.43665822[source]
It's basically the same unholy finger pointing game as municipal permitting only it's all spread out over multiple entities so it's not like you can just sue the town as a whole like one would do when faced with contradictory approvals/denials.