As corporate insurers continue to bank record profits at patients’ expense, the federal government is taking an important step to rein in one of insurers’ abusive practices used to delay and deny care.
The Washington Post reports:
- “More than a year after it was initially proposed, the Biden administration announced a final rule yesterday that will change how insurers in federal programs such as Medicare Advantage use prior authorization — a long-standing system that prevents many patients from accessing doctor-recommended care.”
- “But the new rule goes only so far, affecting just insurers doing business in federal programs, such as Medicare Advantage and Obamacare exchanges. Notably, it doesn’t cover insurance that some 158 million Americans get through their jobs — the most common kind of coverage in the United States. KFF surveys show that ‘this population has problems with prior authorization almost as much as those with [Affordable Care Act] marketplace, Medicaid and Medicare’ coverage, said Kaye Pestaina, director of KFF’s Program on Patient and Consumer Protection.”
- “Doctors and patients are outraged over prior authorization,” which “requires patients and their doctors to seek approval from insurers before proceeding with a treatment, test or medication. Insurer payment is often contingent upon obtaining prior authorization, which may be demanded for everything from expensive cancer care to prescription refills … [T]he process can be confusing and lengthy. Denials are common and appeals are often difficult to navigate. Doctors say some people end up dying while waiting for an insurer’s permission for care.”
The final rule comes as evidence continues to mount that corporate insurers are pursuing profits by routinely delaying and denying care for patients. It also comes on the heels of a report by the Medicare Payment Advisory Commission (MedPAC) revealing that corporate insurance companies are projected to take more than $88 billion in overpayments from the Medicare program in 2024.
Yet at the same time, corporate insurers and other powerful special interests are lobbying Congress to enact harmful Medicare cuts to hospital care that would put patients at risk and threaten access to crucial services that only hospitals provide.
It is critical for lawmakers to reject these harmful Medicare cuts to hospital care and instead take further steps to hold corporate insurance companies accountable for delaying and denying care for patients.