New survey results from the American Medical Association (AMA) suggests physicians and patients are struggling against prior authorization rules set by the health insurance industry which they say has been reluctant to address the problem so that patients can receive greater access to necessary medical treatment. Medical care is still restricted by the practice of repeatedly faxing paperwork, placing multiple phone calls and waiting hours on hold
“Physicians follow insurance protocols for prior authorization that require it. At the same time, patients’ lives can hang in the balance until health plans decide if needed care will qualify for insurance coverage,” said AMA President Barbara L. McAneny, M.D. in a prepared statement.
“In previously released AMA survey results, more than a quarter of physicians reported that insurers’ extended business decision-making process led to serious adverse events for waiting patients, such as a hospitalization or disability. The time is now to fix prior authorization.”
Last year the AMA and other national organizations signed a joint consensus statement outlining five key areas for industry-wide improvements to prior authorization processes and patient-centered care: Selectively apply requirements, adjust the volume of requirements, make rules clear and accessible, support continuity of patient care, and accelerate the use of automation. They say little has been done to implement those changes.
The report found that insurers in some states, Pennsylvania and Vermont are two, have made some progress on lifting prior authorization requirements for treating patients with opioid-use disorder. “This cooperation stands in stark contrast to the situations in Kentucky and Montana, where insurers have actively opposed removing prior authorization for treatment of opioid use disorder despite the human costs resulting from delayed or disrupted access to treatment,” the report states.
AMA said it now wants to generate more public involvement and has released new videos that show “the crippling delays and dysfunction that prior authorizations introduce into healthcare, and the needless harm that can result.” Patients can share their own personal experiences with prior authorization by signing a patient petition at FixPriorAuth.org.
