Doctors Offers Alternatives to HMSA Pre-Approval Policy

H​awaii Neurological Society members are convinced that HMSA’s pre-authorization requirement for all advanced x-ray procedures compromises timely patient care and should be abandoned, the president of the group said Wednesday.
​The comments come amid growing frustration about the policy, which Hawaii’s largest health insurer put in place in December.

Doctors say the policy puts patients’ health at risk, but the insurer disagrees.

Dr. Peter Rossi, president of the Hawaii Neurological Society, says it’s vital that a solution to hammered out.

“We have told them we agree with oversight and that we would work with them to look at the decisions that neurologists make regarding MRIs and other aspects of their care, but after the fact, after the patient receives the care that they need,” he said.

HMSA requires pre-approval for MRIs, CAT scans and other advanced imaging, saying doing so prevents unnecessary tests. Arizona-based National Imaging Associates decides on Hawaii doctors’ requests.

Dr. Scott McCaffery, president of the Hawaii Medical Association, believes the American College of Radiology and the North American Spine Society are better qualified to handle pre-approvals and could do them faster than the Arizona company HMSA uses. 

“In healthcare, moments do matter,” he said. “If we still have problems with any doctors that are over-utilizing, we can take care of them at the Hawaii Medical Association through our peer review committee.”

Rossi said many neurologists whose test requests were initially denied by National Imaging had the decisions reversed on appeal.

For his part, McCaffery wants a timeout on pre-approvals so physicians and HMSA can reach a compromise. “So far they’re not buying it. But we’re going to persist in this area because we know it’s right for the people and the patient,” he said.

Rossi added, “We believe that our neurologists should be working on behalf of their patients and seeing patients, not hanging on the phone trying to overturn a wrong decision by an insurance company.”

HMSA was not available to speak on camera. HMSA Chief Medical Officer Dr. Mark Mugiishi provided the following statement:

The program we have in place today protects physicians and HMSA members by allowing physicians to get an automatic approval for any service that’s needed urgently. Physicians or their staff members can get this automatic approval online or by phone. The response is immediate.

Earlier this month, we met with a local physician advisory panel to address any additional issues. This panel was created and convened in an effort to better hear and serve the physician community. It’s made up of doctors from a number of specialties, PCPs, radiologists, and neurologists, included, and it has recurring meetings scheduled. We’ve also invited a leader of HMA to participate. So far, we’ve received very helpful feedback which we are working to operationalize and we will continue to listen and modify this program as long as it’s in the best interest of our members.

Source: Hawaii News Now

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