Kaiser Health News (3/10, Sausser) reported, “Originally focused on the costliest types of care, such as cancer treatment, insurers now commonly require prior authorization for many mundane medical encounters, including basic imaging and prescription refills.” In a 2021 survey (PDF) from the “American Medical Association, 40% of physicians said they have staffers who work exclusively on prior authorization.” Moreover, “instead of providing a guardrail against useless, expensive treatment, pre-authorization prevents patients from getting the vital care they need, researchers and doctors say.” The federal government in December “proposed several changes that would force health plans…to speed up prior authorization decisions and provide more information about the reasons for denials,” and several states “have passed their own laws governing the process.” While groups including AMA “have expressed support for the proposed changes, some doctors feel they don’t go far enough.”
Related Links:
— “Insurance requirements for prior authorization may prompt ‘devastating’ delays “Lauren Sausser, Kaiser Health News, March 10, 2023