I help doctors, physician assistants, and nurse practitioners successfully navigate the insurance authorization process,
and get prior authorization "right out of the gate."
Hi, I'm Bob Neaderthal, MD,MBA
I've seen prior authorization from both sides.
First, as a practicing physician.
I'm a board certified Internist and fellow of the American College of Physicians. For over 30 years I practiced primary care in Nashville, TN.
I spent many hours while practicing medicine trying to obtain prior authorization for imaging studies for my patients. I know what it is like to get a denial on a CT or an MRI, and the frustration of having to wait on hold while appealing a denial with a medical director with a peer-to-peer phone call. During my years in practice, I witnessed one side of the prior authorization issue, but I kept wondering if there was a better way to obtain diagnostic tests for my patients.
Then as a Medical Director at a prior authorization company.
In 2010, I retired from private practice and began working for a Radiology Benefits Management company (RBM) as a medical director. RBMs are those organizations that contract with insurance companies to provide prior authorization for advanced imaging – CTs, MRIs, PET scans as well as nuclear cardiac studies.
Every day, I reviewed hundreds of requests and appeals, and I participated in dozens of peer-to-peer phone calls with providers who wanted their denied imaging study overturned and approved.
I kept seeing physicians struggle unsuccessfully, over and over.
Many physicians receive the same denials repeatedly. I saw denials based on criteria the physicians and patients had actually already met. I saw how one incorrect clinical answer could lead to hours of wasted admin time. I saw trends in denials but I also saw opportunities.
I also saw the negative effects on physicians and patients.
Frustration. Depression. Burnout. Premature retirement. These things affected each physician I spoke to.
Patients too were adversely affected by prior authorization and denials, with confusion and anger at delayed diagnoses.
But I saw an opportunity to help.
With my experience running my practice, and now my knowledge into how prior authorizations worked, I saw how, with a few hints and tips, physicians could better navigate this bewildering process.
I learned that many denials are avoidable if only providers knew more about how the prior authorization process works and how to get a quick approval.
Helping physicians avoid P2P phone calls has become my mission.
I created this site to help my colleagues - physicians, nurse practitioners, and physician assistants, learn what they can do to avoid P2P calls.
Drop me a note, say hi, and let me know how I can help.