Congressional Candidate Hits Aetna Policy On Prior Authorization Of Opiod-Based Medicines

Tuesday, February 13, 2018
Dr. Danielle Mitchell
Dr. Danielle Mitchell

Dr. Danielle Mitchell, candidate for U.S. Congress of Tennessee’s 3rd Congressional District, and board-certified primary care sports medicine physician, is critical of a new policy instituted by Aetna insurance.

The policy now requires prior authorization for any opioid-based pain medication prescription written for longer than seven days.

She said, "While on the surface, this policy may seem like an effective deterrent against the growing problem of opioid abuse, it actually puts a hardship on patients and healthcare workers while benefitting Aetna.

She said:

  • It prevents patients who legitimately depend on long-term opioid pain prescriptions from accessing the care they need...and is forcing them to pay for their prescriptions out of pocket or not be able to access their medicine putting them at risk of severe health complications and in some cases even death
  • It adds significant burden, cost and inefficiency for healthcare providers, who must often wait on hold sometimes in excess of 45 minutes to procure a single Prior Authorization or are expected by health insurance companies to hire extra staff to cover the paperwork burden insurance companies are piling onto healthcare providers
  • It offers a chance for Aetna to increase profits by discouraging prescriptions, and reducing the number of claims they have to pay out...all under the false pretense of fighting a devastating problem affecting people all across Tennessee while still collecting the same amount in premium payments from patients

Dr. Mitchell, a Democratic candidate, said, "This policy lines the pockets of Aetna stakeholders while making life more difficult for healthcare providers and patients who rely on these medications," Mitchell said. "For example, some patients with severe arthritis, cancer or survivors of physical trauma suffer from debilitating pain and can not take other forms of pain medication as these alternatives can lead to serious complications such as GI bleeding which has attributed to a significant number of deaths particularly in our elderly population." 

She said, "In my medical practice, I have felt the negative effects of the policy first hand.

"I've personally spent hours on the hold trying to procure a prior authorization, only to get cut off 45 minutes into the call after waiting on hold. This not only impacts the healthcare providers workload, but it makes us late to see all of our patient's in clinic thereafter.

"I've attempted to speak with Aetna's executive resolution team on a recorded line to file a complaint on behalf of my patient's and healthcare providers only to be told that it is Aetna's policy to not participate in phone calls with other parties on a recorded line though they state they are allowed to record their calls for 'training purposes'. All the while, my patients are forced to suffer debilitating pain which impacts their work schedules or have to pay for prescriptions out of pocket. This strikes me as yet another example of insurance companies profiting off the burden of disease and adding more inefficiency and cost to an already struggling healthcare system."

She said she is filing a complaint on behalf of patient's and health care providers with the Tennessee Department of Commerce and Insurance. She said, "I am skeptical the complaint will go anywhere as the complaint is handled by the National Association of Insurance Commissioners which is an organization that is funded...by private insurance companies. Tennesseans deserve a congressional representative who will fight for them rather than accept campaign donations from insurance giants and then silently sit back and do nothing."

To view her video recorded conversation with Aetna and the complaint filed to the Tennessee department of Commerce and Insurance go to: www.facebook.com/mitchell4congress 



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