FS
Freda S

1 reviews | Active since Jan 2018

28 Nov 2018, 13:54

Hospital Authorisation Process

My father saw the specialist today at 9h30. The specialist immediately requested that we get authorization for ICD 10 Code -I63.3 (STROKE) I called Topmed Pre-Authorizations and the agent asked me for symptoms of the patient and then insisted on the treatment plan. I am not the doctor but correct me if I am wrong, if the necessary test are not done, how can the doctor give a treatment plan without establishing the damage caused by the stroke and the way forward?

The specialist then wrote the motivation letter ( I received 12h20) stating that "a stroke is a serious condition" and I submitted that to them. Calling them to notify that I have send the email and was advised that they will communicate via email on the authorization. After 40 minutes I called back and asked for the authorization update, only to be informed that they receive a high volume of emails, and it will take 2 hours for the email to be processed.

According to GOOGLE:

A stroke is a serious life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. Strokes are a medical emergency and urgent treatment is essential. The sooner a person receives treatment for a stroke, the less damage is likely to happen.

But TOPMED needs the treatment plan before giving authorizaton!!!

You tell me if I am being unreasonable for trying to get my dad admitted ASAP and have NO appreciation for TOPMED's attitude towards this case?

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Replies (2)
TopMed Medical Scheme
TopMed Medical Scheme's reply28 Nov 2018, 14:30
Official
Dear Freda S

The authorisation has been released as per the call with our Pre-authorisation department.

Kind Regards

Shaun Gaines

TopMed Medical Scheme
FS
Freda S's update28 Nov 2018, 20:28
Reviewer Update
Thank you Shaun - just very sad that the authorization was given directly because of the complaint on HelloPeter. Up until you called me, there was NO intention from Topmed to give authorization.