Here are 11 notes and quotes physicians should know about prior authorization that Becker's has covered so far in 2023:
Stats on prior authorization
Ninety-four percent of physicians reported that prior authorization led to delays in patient care and has caused increased administrative burden.
Thirty-nine percent of physicians spent one to nine hours on prior authorizations weekly in 2022.
Healthcare systems eliminating, addressing prior authorization requirements
Eight major U.S. health systems have canceled their Medicare Advantage contracts so far in 2023, often citing low reimbursement rates and prior authorization hassles.
Humana has rolled back a prior authorization requirement for cataract surgery for Medicare Advantage beneficiaries in Georgia.
Cigna Healthcare has removed nearly 25 percent of medical services from prior authorization requirements, cutting more than 600 codes.
Blue Cross Blue Shield of Michigan announced a new effort to reduce prior authorization requirements by 20 percent in order to improve healthcare quality and access while reducing administrative tasks.
UnitedHealthcare started a two-phased approach to eliminate prior authorization requirements for several procedure codes, aiming to cut prior authorization by 20 percent.
States addressing prior authorization
California legislature is considering a bill that would prohibit prior authorizations for any healthcare service if the plan or insurer approved — or would have approved — not less than 90 percent of the prior authorization requests a provider submitted in the most recent completed one-year contracted period.
Michigan launched new prior authorization rules in June in an effort to make the process faster, more effective and more transparent.
Physician voices on prior authorization
Barbara Jung, MD, President of the American Gastroenterological Association: "Prior authorization has become increasingly utilized by insurers who provide no rationale or data to justify its implementation. This often results in serious health care access issues and adverse patient outcomes due to significant delays or outright denial of care. Instead of getting timely treatment, many patients have told us that the stress of fighting their own insurance company exacerbates their conditions."
Benjamin Levy, MD, Gastroenterologist with University of Chicago Medicine: "Many gastroenterologists are concerned about prior authorization and advanced notification processes causing delays in cancer diagnosis for patients with alarm symptoms and medical management in general. As a physician community, we breathed a sigh of relief when the proposed new prior authorization requirements for [UnitedHealthcare] were changed to advanced notification."