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05/02/2014: "Big Insurance and "The Sentinal Effect""


Dr. Benjamin Brewer had a great article on the Wall Street Journal site about insurance companies requiring preauthorization for medications and services. Most people don't know, as mental health professionals, we almost always face the same unjust scrutiny by big insurance. As this quote points out, insurance companies, in an effort to save money, hope that by making the preauthorization process as difficult as possible, we will all just give up, saving them money.

"They want me to incur the overhead and frustration that comes with trying to prove to a non-doctor that I know my patient and what I'm talking about. They want to cut costs, and they don't really care about how it affects my patients or my practice. If they make the process hard enough, they hope I'll just give up. There is even a term in the managed care literature for that kind of deterrence: the "sentinel effect."

Just so you don't have to click over, the Sentinal effect "deters utilization by requiring the administrative effort necessary to authorize the procedure. Studies have shown the sentinel effect to be persuasive."

This "administrative effort" transfers over to big money, in my practice at least a third. Of course this is passed on to our patients, but not the one's who have insurance, as the insurance companies won't pay us for the time it takes to cut through their red tape. Instead, we have to charge higher rates, and pass the costs on to our private pay clients.

Just another example of how Big Insurance IS the problem in healthcare... Not the answer.

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