This month is Breast Cancer Awareness Month, and in treating cancer, early detection and treatment can mean the difference between life and death. Yet despite life-saving advances in cancer treatments and preventative care, many patients still experience excessive delays and face unnecessary barriers in accessing care imposed by some corporate insurance companies. In case you missed it, according to MedPage’s reporting, some corporate insurers are abusing prior authorization to delay or avoid paying for medically necessary cancer care, even when there is a clear and urgent need for it.
A recent study in JAMA found that among 206 prior authorization denials in radiation oncology, more than two-thirds were ultimately approved on appeal without changes. This indicates these prior authorization requests should never have been denied in the first place. In another study published in JCO Oncology Practice, researchers found that more than 86% of denied requests were ultimately approved with few changes.
These excessive delays in access to care come at a significant cost to patients. Of the patients examined in the JAMA study, treatment delays ranged from one day to as many as 49 days. And these are life or death situations for many patients fighting cancer who need time-sensitive, lifesaving treatment; 83 patients died during the study or within two years of its conclusion.
In a separate study published last year, the JAMA study’s author Dr. Fumiko Chino and her peers also found that:
- 69% of patients with cancer reported delays in care related to prior authorization, with a third waiting a month or longer.
- One in five patients never got the care their doctors recommended.
- One in five also reported spending more than 11 hours on the phone haggling with their insurance companies.
- Most patients rated the process as “bad” or “horrible” and said it fueled anxiety.
Excessive prior authorization also drives up costs significantly for physician clinics and hospitals, placing financial strain on the facilities that communities count on and contributing to physician burnout. Surveys by the American Medical Association have repeatedly found that more than 90% of physicians say prior authorization denials delay care and have a negative impact on patients, and almost a quarter say delays have led to serious adverse events for patients.
In the worst-case scenarios, oncologists may receive prior authorization approval to treat a patient’s condition when it’s too late to pursue their treatment plan, as the patient’s condition has worsened and requires more drastic intervention. As physician Dr. Fantine Giap said, “knowing the majority of the cases are ultimately approved and that this wait is often unnecessary makes it even tougher.”
It’s time for Congress to hold corporate insurers accountable for excessive and improper prior authorization delays and denials. Without action to reform prior authorization and prevent its abuse by some corporate insurance giants, patients will continue to face unnecessary barriers to life-saving treatment.