In case you missed it, a recent American Medical Association (AMA) survey shed more light on how excessive prior authorization policies used by many corporate insurance companies delay and deny care, putting patients at risk and creating unnecessary administrative burden for physicians.
Here’s what 1,000 practicing physicians from across the United States had to say about prior authorization:
Prior Authorization Policies Pose Barriers to Care Patients Need
- Seventy-eight percent of physicians say that prior authorization policies sometimes or often result in patients abandoning their recommended course of treatment.
- Ninety-four percent of physicians share that prior authorization always, often or sometimes delays patients from receiving necessary care.
- And these barriers to care have a direct impact on patients’ health: Nearly one in four physicians report that “[prior authorization] has led to a serious adverse event for a patient in their care.”
- Nineteen percent of physicians report that prior authorization requirements caused an adverse event leading to a patient’s hospitalization.
- Seven percent of physicians report that prior authorization requirements caused an “adverse event leading to a patient’s disability, permanent bodily damage, congenital anomaly, birth defect or death.”
Prior Authorization Policies Overburden Physicians and Providers
- Ninety-five percent of physicians say prior authorization “somewhat or significantly increases physician burnout.”
- Twenty-seven percent of physicians report that prior authorization requests are often or always denied.
- Physicians and their staff spend, on average, 12 hours a week on prior authorization requests, reducing the time providers are able to spend with patients.
- More than 35 percent of physicians have staff who work exclusively on prior authorization.
This new data aligns with previous reports of certain corporate insurers padding their profits at the expense of patients:
- Last year, an NBC News investigation found that corporate insurers that take money from Medicare “routinely reject claims for necessary care.”
- A January MedPAC report revealed that the federal government “is projected to pay privately run Medicare Advantage plans $88 billion more in 2024 than it should” as reported by POLITICO.
- A recent New York Times investigation shed light on how corporate “insurance companies often weaponize [prior authorization] in order to control doctors and inflate their [own] profits.”
In addition to these harmful practices, some of these same corporate insurance companies are using their profits to lobby Congress for sweeping funding cuts that would reduce patients’ access to care even further. Harmful “site-neutral” policies are simply major Medicare cuts that would fall disproportionately on the patients and hospitals that are already at the greatest risk — including underserved populations and rural communities.
The cuts to care that insurers are advocating for would negatively impact crucial service lines that are already at risk, such as ICUs, emergency care, and obstetric care. If lawmakers listen to insurers’ lobbying and enact these Medicare cuts, many more local hospitals could be forced to close their doors — and patients would be left with even fewer avenues to access the care they need.
Patients deserve access to high-quality, 24/7 care. New analysis reveals that nearly half of yearly visits to emergency departments happen outside of regular business hours, highlighting the importance of that access. Policymakers shouldn’t let giant corporate insurers put their own profits ahead of patients’ health and well-being. They should hold corporate insurers accountable for their arbitrary policies like prior authorization that systematically delay and deny care for the American people.