Prior Authorizations Are Becoming Increasingly Burdensome — and Dangerous — for Patients

By Josh Garcia
Monday, January 6, 2020

More than 90% of physicians surveyed by the American Medical Association (AMA) say that prior authorization (PA) delays access to necessary care.

The continuing necessity of PA by insurance companies for certain treatments is more than a minor annoyance for many physicians and their patients. In fact, among the thousand physicians that the AMA surveyed for its 2018 PA Physician Survey, 28% felt that the PA process had led to serious adverse events among their patients, with a serious adverse event being defined as “death, hospitalization, disability/permanent bodily damage or other life-threatening event.”

In addition, PA is taking a toll on the time and energy of physicians and their staff. On average, practices spend 14.9 hours — almost two business days — on completing PAs every week, with more than a third of practices keeping members on staff dedicated exclusively to PA work. The burden of PA has increased over the last five years, according to 88% of surveyed physicians.

Whenever possible, the AMA recommends handling the PA process through a standardized, automated system to minimize burdens and optimize care. This system should help physicians document data for PA in medical records, check PA requirements before administering services, ensure regular follow-ups regarding PA approval and allow for effective appeals when PAs are inappropriately denied.