MANAGED CARE October 2004. ©MediMedia USA
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."