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AMA Releases Survey on Prior Authorization Process

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AMA Releases Survey on Prior Authorization Process

The American Medical Association (AMA) recently released a web-based survey conducted among 1,000 practicing physicians regarding their views on the Prior Authorization process. Prior Authorization (PA) is a process used by many U.S. health insurers to determine whether they will approve coverage of a prescribed procedure, service, or medication. This process takes into consideration a host of factors, among which are medication cost, safety, and appropriateness. While Prior Authorization has largely become standard practice across insurance companies nationwide, both patients and physicians are experiencing significant and, at times, irreversible drawbacks as a result of this process.

The Prior Authorization process often leaves patients waiting to be able to begin a treatment or medication prescribed as necessary by their physician. According to the AMA survey, 91% of the surveyed physicians reported that the PA process at least sometimes delays access to necessary care, with 65% of physicians reporting waiting at least one business day for a PA decision, 26% of which report waiting at least three business days. Moreover, 28% of physicians informed AMA that the Prior Authorization process had led to a “serious adverse event (e.g., death, hospitalization, disability/permanent bodily damage, or other life-threatening event)” for one of their patients due to the delay in care. Many patients end up abandoning treatment altogether because of PA, according to 75% of respondents. Overall, 91% of physicians report that Prior Authorization has a “significant or somewhat negative impact” on patient clinical outcomes.

AMA is advocating to reform the Prior Authorization process to reduce its damage to both patients and physicians. This reform initiative encourages insurance companies to abide by a list of principles under areas such as clinical validity, continuity of care, transparency and fairness, and timely access and administrative efficiency.

If you or a family member has encountered problems with the Prior Authorization process used by a health insurance company, contact the Law Offices of Scott Glovsky. Our team of knowledgeable attorneys may be able to help.

Sources:
https://www.ama-assn.org/system/files/2019-02/prior-auth-2018.pdf

https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/principles-with-signatory-page-for-slsc.pdf