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Editorial

Health insurance: A painfully long wait

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One million hours. That’s how much time new Harvard research suggests psychiatrists spend each year obtaining insurance approval to hospitalize suicidal or mentally ill patients. That translates into time taken away from patient care but also, more importantly, means patients in crisis are stuck in emergency rooms for a median of 8.5 hours, more than twice the length for most other admissions. This bureaucratic roadblock needs to be streamlined.

The study, published April 23, looked at data from more than 1,000 patients, including a small sample at Cambridge Health Alliance. Unlike if they were suffering from a gunshot wound or appendicitis, privately insured patients with psychiatric illnesses generally need prior authorization for reimbursement to be admitted. Approval almost always comes, the study found, but doctors spent between less than 20 minutes and five hours on the telephone getting it. With 1.6 million psychiatric admissions per year, that adds up. One result is that emergency rooms are now being designed to ensure that waiting psychiatric patients can’t harm themselves or others in the meantime.

The study’s authors call for this extra approval step to be eliminated, suggesting the only benefit is cost-savings due to deterrence — or what they call “rationing by hassle factor.” But, given that doctors may also receive important medical history during the call, particularly for regular ER visitors, insurers should instead expedite the approval process. Right now patients’ — and doctors’ — best interest is being lost amid paperwork.

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