Nothing is more frustrating for both patients and their healthcare providers than preauthorization by middlemen that exist to make healthcare more frustrating and difficult for anyone needing to access the system. In the chiropractic profession, many of these companies have become wealthy while the doctors beg for additional care and have paperwork through preauthorization that does nothing to improve care. Often, medical and chiropractic providers attempting to pre-authorize are taken away from their patient care to speak with a medical gatekeeper instead of helping patients. This needs to stop or be markedly reduced. Years ago, my son had a gallbladder problem that could be diagnosed by an exam that needed to be done through the Barnabas Systems facilities. The test was initially denied, and then it was approved, but only for one part of the test. We were told that if the first part of the test were negative, the facility could call to proceed with part 2 during the middle of the test. The company, Evicore, which was paid by Horizon Blue Cross, was well known for delay, deny, and defend tactics. Ironically, my plan had a high deductible at the time, which we had to meet, so the plan only had to put the cost of the test using their fee schedule as my responsibility. The day of the test, only the first test was approved, and then we had to reschedule, and they had to repeat both tests a week later, which was also my responsibility financially. Luckily, my son did not require gallbladder surgery, but what they put is through was awful, and we were paying thousands for the coverage. Last week, a patient who had had knee pain for months asked if I could order an MRI. Again, I needed to recertify through Evicore, who again delayed first by playing the we need your notes game and then the we didn’t see records of an X-ray in the file. The patient was told that this was not approved, and I usually order fewer than 10 MRI scans yearly. On the medical side, they order thousands, and many of these are done in the absence of a thorough evaluation or treatment to resolve the problem first. We wouldn’t have a problem if they did not liberally order these tests that often required a thorough evaluation to be meaningful. If insurers incentivised better evaluations and paid doctors to do them instead of just referring patients from doctor to doctor, we would have healthier patients, fewer prescriptions, and lower healthcare costs with less patient frustration. These problems are worsening as nobody has any plans to reduce healthcare costs, whether in Medicare or regular insurance. What they do instead is make it difficult to get the care you need, often with fatal consequences for certain people. On the other hand, there is truth in the statistic that 5% of the people are super users and the rest of us are not. It is also true that primary care as I knew it is gone replaced by urgent care which is protocoled care for many common conditions that often does little to cure a problem or the dreaded Emergency room which is a room where you wait to be called, have your bloods taken, wait longer see a doctor for a short visit and get a ridiculous bill. What can we do better to improve the experience of healthcare? Eliminate precertifications for most services. Medicare has few, if any, certifications, while private insurers have increased the number of certifications to reduce the number of people they need to pay for. Medicare-insured patients have better experiences, lower costs, and fewer hoops to jump through. Currently, insurance companies are beginning to bend to political pressure to reduce the amount of preauthorized services. In most cases, preauthorization adds little or no value and is just a stumbling block for patients and their healthcare providers. According to the website “The Hill”, Major health insurers, including Cigna, UnitedHealthcare, and Aetna, said they would be simplifying the process and reducing the number of health care claims subject to prior authorization. Should we believe them after legislation is drafted, this past May was lobbied into non-existence. Teaching doctors to do better evaluations and incentivize evaluations and disincentivize the tests. In the current environment, doctors jump to where the incentives are, which is why gastrointestinal doctors who still work for themselves now own many of the surgery centers where they work, which has increased their earnings. While their procedural fees were reduced, the facility fees from these places are absurdly expensive. Send patients with musculoskeletal complaints to chiropractors first. The best chiropractors improve outcomes faster, as borne by most research, and they are the only profession trained to perform primary care to the musculoskeletal system. Rather than the piecemeal model, which is highly inefficient, a chiropractor, such as a chiropractic sports physician, will reduce costs, tests, and visits by holistic evaluation and treatment of the condition. In Medicare, the evidence is strong that the opioid crisis could not have happened without the medical profession overprescribing pain medication when there were better options available. Currently, the Chiropractic Medicare Modernization Act legislation will fully cover chiropractors in Medicare up to the modern level of their state licensure, but the legislation must be voted on first. Call your legislator and tell them you want this passed so chiropractic coverage is complete instead of the current manipulation-only coverage that makes care more expensive than it should be. Medical providers who have worked side by side with chiropractic physicians in the VA and in hospitals and multi-disciplinary practices have been impressed with the knowledge and helpfulness of staff chiropractors. Fix the Medicare fee schedule problems, reducing fees for physicians yearly, because Congress has failed yearly to repair the funding formula, which has reduced Medicare reimbursements for participants yearly, ignoring increasing costs and inflation in general. This has caused further consolidation, shorter doctor visits, and financial stresses for smaller practices that have the same inflation you experience while trying to run a healthcare business. Offer Medicare buy-ins for more people who want to get out of our current chaotic system, which is an unmanageable mess and getting worse. Medicare has coverage both in and out of network in all 50 states, and most doctors participate. Medicare also limits what a doctor can charge, which eliminates medical price gouging. Patients can often get an MRI for $400 or under by paying cash at the time of service. Often, this will cost less than waiting for an insurer to reprice a billed service and may be worth it since MRI centers will fill their unused appointments with those who are willing to pay outright. Sometimes it is just worth it, and you can use your medical savings accounts for these costs.