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AMA, AHIP Find Common Ground on Preauthorizations

Jeff Elliott, for HealthLeaders Media, December 15, 2010

One of the biggest historical rifts between health plans and providers has been rules that require physicians to clear procedures, tests, and even medications with a patient’s health plan before they are administered.

Each side has conceded ground on this issue over the years—providers accepting preauthorizations as a way to help control costs and insurance companies loosening their policies to give physicians greater discretion. But that hasn’t’ stopped the two from taking jabs one another.

The latest from healthcare providers came in the form of an American Medical Association survey in which 2,400 physicians weighed in on their preauthorization experiences:

  • More than one-third of physicians said they experience a 20 percent rejection rate from insurers on first-time preauthorization requests for tests and procedures, with 46% indicating they have difficulty obtaining approval from insurers on 25% or more of preauthorization requests for tests and procedures.
  • Nearly two-thirds of physicians said they must wait several days to receive preauthorization from an insurer for tests and procedures; for 13%, the wait more than a week.
  • Sixty-four percent of respondents stated they found it difficult to determine which test and procedures require preauthorization by insurers, and 67% reported difficulty determining which drugs require preauthorization by insurers.

"Intrusive managed care oversight programs that substitute corporate policy for physicians' clinical judgment can delay patient access to medically necessary care," said AMA Immediate Past President J. James Rohack, whose organization estimates that physicians spend 20 hours per week on average dealing with preauthorizations at a cost of $23.2 to $31 billion a year.
The study’s results were less than phenomenal, confirming a fact that we all know: preauthorizations are a pain in the posterior, which was confirmed in AMA’s conclusion that preauthorizations weren’t so much a bad thing, just something to be improved upon.

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1 comments on "AMA, AHIP Find Common Ground on Preauthorizations"


Arnold Herman MD FACS (12/16/2010 at 5:20 PM)
The biggest problem with prior authorizations is that even when we go through the process to obtain prior authorization, there is no certainty that the test/procedure will be paid for by the insurance company. The disclaimer that "prior autorization does not guarantee payment" should be eliminated, ot the prior autorization for that procedure removed.