Highmark strikes again

Reason #397 that Highmark is worse than Aetna. I just found out from my pulmonologist's office that Aetna didn't require pre-authorization for routine 3-month follow-up CT scans. Highmark does. And they don't allow the medical provider to start the pre-authorization process until about 12-14 days before the target date. May 13 is 3 months, but they won't let my doctor submit the paperwork until May 1.

I have no idea how many days it takes to get approval, but it's likely that I'll only find out maybe 1 week beforehand when the CT scan will scheduled. Thankfully the semester will be over so I'll have plenty of flexibility. However, the February scan was scheduled weeks ahead of time, and even then I only had 2-3 options in a 5-day period, one of which was 7am, if I recall. In other words, scheduling could be a bit of a nightmare, especially in November and February when I am teaching and have standing meetings for my department and program, Faculty Senate, research teams, etc.

This is also tricky because my oncology appointments in Pittsburgh are set first, so the CT scan here in State College has to occur during a certain time frame. I can't push back the CT scan without having to reschedule the oncology appointment.

If you could design an insurance company that makes life difficult for patients and health providers, you would create Highmark.

*edited to add: Others have pointed out that Penn State negotiates our health insurance plan with Highmark. They can make the plan design whatever they want it to be. Leland was flabbergasted when he went to fill a malaria prescription for an upcoming trip and was told that Highmark only approves 7 pills without preauthorization. Seven pills are useless because you have to take the medication before, during, and after a trip. So now his doctor has to go through the whole preauthorization process just for a simple malaria script. 

It is infuriating to realize that when PSU executives set the plan design with Highmark, they decided they could save money by making employees reauthorize every routine, follow-up CT scan, get preauthorization for malaria medication, and pay more for medications (in some cases 300-500% more). And I'm sure that's only the tip of the iceberg.