Prior Authorization — Big Delays Causing Big Problems

The American Medical Association has a big complaint. It says 94% of physicians have reported that care was skipped by a patient because of long delays in preauthorization requirements by health insurers or state regulators involving health insurance.

Here’s what the AMA had to say about its physician survey that took place in December of last year:

  • As we just noted, 94% of patients had care delayed
  • 80% say advance treatment approvals led to early treatment abandonment
  • 31% found preauthorization criteria set by state regulations or individual insurer parameters are rarely or never evidence-based
  • 33% found that prior authorization led to a serious adverse event
  • 9% reported delays in prior authorization led to permanent bodily damage or death

As for the effectiveness of prior authorizations:

  • 86% say preauthorization does lead to a higher overall utilization of healthcare resources
  • 64% say the preauthorizations have led to ineffective initial treatments

By the way, on average the nation’s doctors say they handle 45 preauthorization requests a week. The contend they spend two business days each week managing those authorizations. Of those responding, 35% say they have had to hire additional staff devoted exclusively to the administrative duties attached to prior authorization requests.

Source link: Business Insurance —

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