Priority Authorization Impedes Effective Health Care For Seniors

Priority authorization is needed for many procedures before a patients’ doctor can actually proceed. For example, MRI’s, PET scans, radiology, and others will usually require a priority authorization before the doctor can do the procedure.

 

In many cases, especially when the patient is a senior citizen, time is critically important. And, waiting for that authorization from the insurance company to come through often can take several days. And, in many cases, the initial request is denied and additional days and appeals are necessary to get that approval. In addition, there is a ton of paperwork to file with the insurance providers.

 

A physician needs a full-time staff just to process and submit these requests. And, of course, patients always blame their doctor when the authorization is slow to come through.

 

The patient is caught between their insurance provider and doctor. Not good.

 

 

priority authorization

 

 

Priority Authorization: What Are Doctors Doing About Delays?

Physician associations earlier this week, called on U.S. House of Representatives lawmakers to pass legislation to streamline prior authorization.   They rightfully claim that it places undue burden and huge costs on doctors.

 

During a hearing before the House Committee on Small Business, doctors complained that unnecessary requirements delay patient care, lead to physician burnout, and result in worse outcomes.

 

“The prior authorization process is out of control. It is increasing, and rather than a tool for preventing unnecessary or expensive care… and it negatively impacts my patients’ health. It  is a significant cause for family physician burnout and the closure of small private practices,” said Dr. John Cullen, a family doctor told the committee.

Dr. Cullen, has to deal with 35 different health insurers, that all have their own authorization processes that change often. Thus, for patient and doctor, it’s difficult to know what services and medications will be covered.

Dr. Howard Rogers, a dermatologist in Connecticut, said his practice spends 70 hours a week on prior authorization. He hired two full-time staff to handle the volume of prior authorizations, costing him $120,000 in salary and benefits that could have been spent on staff education, improved benefit packages for employees and new medical equipment and technology.

Current Status:

Committee members are receptive to the doctors’ calls for relief. The bill before the committee is called the “Improving Seniors’ Timely Access to Care Act of 2019” and was introduced in June.

 

More than 370 groups including the Federation for American Hospitals and the American Medical Association — along with many other physician groups — signed on this week to a letter of support for the bill. This bill was introduced by Reps. Suzan DelBene (D-Wash.) and Roger Marshall (R-Kan.).

The Bill’s language as currently written streamlines the authorization process. It also loosens requirements medically necessary procedures, especially for critically ill patients.

 

The goal is to stop treatment delays. Doctors hope there will be no delay in getting this bill signed into law.

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