AMA to Congress: Make Plans Respond Within 5 Minutes


The American Medical Association says that physicians shouldn't have to wait more than five minutes to get a decision from health plans on appeals of denied care. AMA delegates at the organization's annual meeting this year complained that doctors often have to wait more than 20 minutes to get an approval, often with the patient in the examining room.

"The result of the delay makes it difficult to maximize care for the patient in question and may make it difficult to appeal a denial of medical care," the AMA notes in a resolution passed by its House of Delegates.

In that resolution, delegates gave the organization the go-ahead to ask Congress to mandate the five-minute waiting period, pointing out that "physicians act as patient advocates to insurance companies to justify needed therapies."

An editorial in the American Medical News, an AMA publication, argues that "If physicians are holding the phone, not knowing when someone is going to pick it up, that takes time away from treating not just the patient who's the subject of the appeal, but every patient who has now been delayed because the appointment is running long," the editorial says. "If staff waits on the phone, that's time taken away from their usual tasks." The AMA, according to the resolution, wants Congress to "write legislation mandating that managed care organizations be required to staff physician contact phone numbers concerning appeals for denied care sufficiently to maintain no more than a five-minute average wait time."

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.