Imagine you’re skiing with friends, enjoying an afternoon on the slopes. It’s the kind of day you’ve been looking forward to for months.
Then, in an instant, everything changes.
An avalanche breaks loose high on the mountain. One member of your group is caught in the rushing snow and nearly buried. You and your friends scramble into action, digging desperately to reach him. Thankfully, you’ve arrived in time to help and everyone makes it home safe.
Safe, but maybe not unscathed. After the crisis has passed, a pain in your knee begins to dawn. It doesn’t seem like much at first. Maybe it’s just sore from skiing. But with each passing day, something feels increasingly wrong. Your knee catches when you walk. Soon, the joint won’t fully straighten. You know it’s more than a sprain and head to the doctor.
An MRI confirms it’s as bad as you’ve been worried it could be. The diagnosis is a torn ACL. You learn the meaning of words like ‘meniscus’ in real time. You also learn that your orthopedic surgeon doesn’t want to wait – the damage may still be repairable, but time matters. Every day that passes stands to make your surgery more difficult and your recovery more uncertain.
So, the surgeon submits the request to your health plan. Now comes the part that so many patients dread. Waiting. Waiting to find out if the surgery can move forward. Waiting to schedule the procedure. Waiting while an injury that needs prompt treatment sits unresolved.
Except this time, that’s not what happened.
When the request arrived at Premera, our authorization technology immediately began reviewing the clinical documentation submitted by the surgeon. In just 1 hour and 8 minutes, the procedure was approved.
Not the next day.
Not several days later.
68 minutes.
Three days after the request was submitted, the member underwent surgery to repair his ACL.
His surgeon recommended surgery and shared the reasons why it was the most appropriate course of treatment. And his health plan leveraged new technologies to get that treatment approved in less time than it takes to watch a movie.
Stories like this one are why Premera is investing in technology to improve the healthcare experience for the members we serve and the providers we work with, including services that help us approve treatment options submitted by providers faster than ever before.
Because every hour we save is an hour our members don’t spend wondering if they’ll get the care they need.
Visit our website today to learn more about why preapprovals are necessary for some procedures and what Premera is doing to make the process better for members and providers alike.
