Payers of medical costs have used prior authorization for years to prevent unnecessary care and possible fraud. A recent survey conducted by the American Medical Association revealed that over 90% of physicians found the practice unduly burdensome because of its negative impact on clinical outcome. 64% of physicians will wait at least one business day for prior authorization decisions and 30% will wait three business days or longer.
Some payers require authorization for simple care such as generic medications. A simple phone call can mushroom into a protracted back and forth that only delays a patient’s access to vital medical care. Telephone ‘hold times’ can be 20 minutes or more. Nearly 80% of physicians reported that patients will abandon a recommended course of care due to the preauthorization maze. In this age of health coverage contraction, patients have limited choices if they want to change health plans. Some suggestions for overhauling the authorization process include speeding up the adoption of electronic standards for prior authorization that will eliminate denials for non-clinical reasons, and employing professionals beyond physician offices who understand the language of medicine. Professional organizations have spoken out that “reducing administrative burden is a must” to not only reduce provider stress but, most important, improve patient outcomes.
AMA survey says prior authorizations hurting clinical outcomes
AAFP: Reducing Administrative Burden a Must
Prior Authorization: Do Insurers Pay Bonuses for Denying New-Drug Requests?
Prior Authorization and Canadian Public Utilization of Direct-Acting Oral Anticoagulants
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