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Prior Authorization Hurts Patient Care, AMA Survey Finds

John Commins, for HealthLeaders Media, November 23, 2010

Requiring physicians to ask for preauthorization from health insurance companies harms patient care, and creates an expensive and confusing claims process, according to a national survey released by the American Medical Association.

"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, MD. "According to the AMA survey, 78% of physicians believe insurers use preauthorization requirements for an unreasonable list of tests, procedures and drugs."

The AMA said the national survey—released this week— of approximately 2,400 physicians is an attempt to quantify the burden of preauthorization mandates for a growing list of routine tests, procedures and drugs. Physicians complained that preauthorization delays or interrupts patient care, wastes time, and complicates medical decisions.

The survey found that:

 

  • 37% of physicians experience a 20% rejection rate from insurers on first-time preauthorization requests for tests and procedures, and 57% experience a 20% rejection rate on first-time preauthorization requests for drugs.
     
  • 46% of physicians had difficulty getting approval from insurers on 25% or more of preauthorization requests for tests and procedures, and 58% experience difficulty getting approval from insurers on 25% or more of preauthorization requests for drugs.
     
  • 63% of physicians typically wait several days to receive preauthorization from an insurer for tests and procedures, while 13% wait more than a week. And 69% of physicians typically wait several days to receive preauthorization from an insurer for drugs, while 10% wait more than one week.
     
  • 64% of physicians have trouble determining which test and procedures require preauthorization, and 67% have trouble determining which drugs require preauthorization.

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    2 comments on "Prior Authorization Hurts Patient Care, AMA Survey Finds"


    Todd (11/23/2010 at 10:32 AM)
    This sure beats the alternative. Imagine no prior authorization? You would see premium increases year over year of 40% being common. What insurance plans and employers should do to compromise is not require prior authorization for patients having surgery at Joint Commission Accredited Hospitals in Thailand, India, Turkey, Korea, Singapore and Costa Rica.

    Sara Gottschalk (11/23/2010 at 10:17 AM)
    As the wife of a patient who was to undergo chemotherapy, I found myself fighting with an insurance company to justify the two heart tests required by a highly respected oncologist who could not determine chemotherapy medication until the tests determined the ability of his heart to withstand the chemo rounds. The insurance company could not correlate the relationship between chemo treatments and heart health! I shudder to think how many patients have legitimate claims denied because they do not have the expertise to fight their way through the system as I did[INVALID]especially at times when they are particularly vulnerable.