Insurer's new policy puts Kingman patients in a world of hurt
Pain management doctor says authorization requests ignored
KINGMAN - Dr. Michael Valpiani has been treating some of his patients for three or four years at his pain management medical office, and now has to release them from his care because of a policy change with Health Choice Arizona insurance plan.
Valpiani, primary doctor at A Better Life pain treatment center, said he's having nightmarish problems getting authorization from Health Choice for each and every patient's office visit since the provider changed its policy in May.
The doctor submits a request for authorization at least 14 days prior to the office visit and Health Choice "sits on it" for two, three, even four months, he said.
"Sometimes they don't respond at all. They let it expire. They told us not to call," Valpiani said during an interview in his office at 3931 Stockton Hill Road. "I cannot challenge them if they're not responding. If they say nothing, you die of your cancer. They have the right to review (the case), but it's six to eight months later."
Rodney Collette, who suffers from peripheral artery disease in both legs and has been disabled since heart surgery six years ago, said he's dropping Health Care "like a hot potato" and switching to United Healthcare. He's heard of no problems with them.
He takes a number of prescription drugs for his medical conditions, including morphine, hydrocodone and Vicodin, and wasn't able to get refills because he was denied doctor visits.
"The problem is, it takes forever to get authorization," Collette said. "It's had me down all month long. I take pain pills in order to walk. If I didn't have them, I'd end up in a wheelchair."
He thinks Health Choice is turning into a bureaucracy like the VA.
"They just forgot about everybody," he said. "Nobody knows what's going on with Health Choice. One doctor said they just got too big. They're just ignoring everybody."
Valpiani said a lot of doctors threatened to quit Health Choice, so the insurer dropped the authorization requirement for everyone except pain management specialists, neurologists and neurosurgeons, and ear, nose and throat (ENT) specialists.
"They're not living up to their end of the bargain," the doctor said. "They told us to let one patient go into withdrawals. They appear to have made no plans to implement this and they have different departments fighting each other. One approves it (authorization) and one denies it or fights it."
Valpiani said he got a call from Health Choice asking why he was turning away patients and sending them to the emergency room at Kingman Regional Medical Center. Another person called and told him he didn't need authorization for the office visit, so he read a letter from Health Choice denying authorization.
Marcia Blain, office manager for Panacea Brain and Spine center in Lake Havasu City, said she wasn't notified about the changes in Health Choice policies until two months later.
"You get claims back that didn't get authorization," Blain said. "From that point on, everything kind of got slower and slower. The biggest issue is we have a neurosurgeon and an orthopedic spine surgeon, so the authorization and referral policy for each of those is different."
The doctors might see patients for the same diagnosis and do the same exact surgical procedures, but because of their titles, one gets approval and the other doesn't, Blain said.
It takes anywhere from 30 minutes to more than an hour on the phone with Health Choice to get authorization for each patient, and the doctors would have to hire an additional employee just to make those calls, Blain said.
She sent a letter to cancel Dr. Chad Hartley's contract with Health Choice.
"Basically, it's poor patient care, as far as we're concerned," the doctors' office manager said. "You get an MRI, then you submit authorization for a follow-up. How's that helping patients?"
Blain said she's heard of other doctors dropping their contract with Health Choice.
"I think it's just confusion with the whole thing," she said. "They said they understand it's unreasonable. It's all about reimbursement time to get authorization."
Laura Waugh, director of marketing and public relations for Health Choice, would not respond to specific questions from the Daily Miner about the difference in authorization policies.
She said Health Choice Arizona strives to offer exceptional service to the more than 230,000 members, and issued the following statement:
"In response to the growing epidemic of prescription drug abuse across the United States, our organization has implemented evidence-based medical management protocols to ensure the appropriate use of medication and pain management therapies.
"We believe that in taking these steps to ensure all treatments and therapies are clinically appropriate, our robust provider network will be better positioned to deliver the high quality of care that we have offered Health Choice Arizona members for more than 20 years."
That's no relief for Collette, whose doctor released him with a letter saying he would provide him with a 28-day supply of narcotic medications and directions on how to taper off.
"It just makes it hard on good people like myself that actually need it," Collette said as he showed a scar on his chest from heart surgery. "I see people all around take prescription medications they don't need. A lot of them are on SSI and there's nothing wrong with them. They're milking the system. That's wrong."
Collette said the drugs only take away about 30 percent of his pain, and he still has trouble walking.
"So you can see why people might overdose. You can get a euphoria with them, but I don't, especially with Norco or Vicodin," he said.
Health Choice doesn't have the manpower or plans in place to implement the new process, Valpiani said. He's also heard of numerous complaints from doctors and patients about AHCCCS, or Arizona Health Care Cost Containment System.
"We've been promised that this problem would be resolved several times and they still haven't resolved it," Valpiani said. "They're so confused. They implemented a policy they have to review, and they're six to eight months behind. Nothing's been done in a timely fashion by their standards or AHCCCS standards."