15/09/2023
Do you ever wonder why it takes so long to get medications, a procedure, imaging, etc.?
Authorizations are a full time job and every carrier has different standards as to what requires authorization and what doesn’t. Each year there are new guidelines implemented for services that we provide which require us to request authorization, when that never used to be the case. This delays necessary and sometimes urgent medical care for patients and burdens medical practitioners and their staff. Often authorizations are denied because the reasoning for medical necessity that was documented in the clinic note and submitted with the request, is overlooked by the reviewer. This leaves staff revisiting a single authorization multiple times and disrupts care for other patients when their visits are interrupted because the practitioner is required to complete a peer review. These reviews are often completed by medical practitioners from a different specialty who do not have medical training or knowledge of the authorization they are reviewing who frequently base their decisions off the insurance guidelines anyways, not medical reasoning. When these denials are upheld we can appeal their denial and sometimes find that the decision will be overturned. If they are not overturned we can request a fair trial court hearing.
This leaves practices spending countless hours over the course of several weeks and sometimes months fighting for their patients care. Often providers are too busy and give up by this point as they are not reimbursed for the burdensome administrative time required to advocate for their patients care and it’s not feasible.
We need change! This is not a sustainable way to practice medicine and hinders our ability to improve patient outcomes.
Hear firsthand from physicians how prior authorization burdens practices and interferes with patient care and learn what the AMA is doing to fix prior author...
