Preauthorization

Physician-Led Results: Grassroots Advocacy Paid Off in Tangible Wins at the Capitol - 10/13/2021

Texas physicians made the most of an extraordinary, scaled-back session of the Texas Legislature in 2021. They helped pass laws to curb prior authorization hassles; keep physicians from incurring new practice costs; install liability protections for future pandemics like COVID-19; extend postpartum Medicaid coverage for new mothers; and keep graduate medical education (GME) fully funded. And so much more.


Medicaid Relaxes Prior Authorization for Hep C Antiviral Drugs - 09/06/2021

For years, Texas Medicaid patients with hepatitis C haven’t had access to overwhelmingly effective, often-curative antiviral therapy unless they had advanced liver disease. In many cases, getting the antiviral drugs at that point was too little, too late.


House OK’s Restriction of Prior Auth for Autoimmune Scrips - 04/20/2021

The Texas House of Representatives on Monday passed a bill that severely restricts insurers’ ability to impose preauthorization requirements for prescriptions for autoimmune diseases.


Eliminating Care Delays and Waste in Prior Auth - 04/13/2021

The House of Medicine brought one strong reason after another to Tuesday’s House Insurance Committee hearing on why lawmakers should support a measure that takes two major steps to reduce physicians’ prior authorization burden.  


Legislative Hotline: Chasing the “Gold” on Prior Auth; Gender-Affirming Care - 04/12/2021

The Texas Medical Association is sending three physician leaders to Tuesday's House Insurance Committee hearing to address the hassles and care impediments of health plans’ preauthorization requirements.


Prior Authorization Hassles Almost Always Cause Care Delays, Survey Shows - 04/12/2021

Most physicians know that health insurers’ prior authorization policies delay access to care, often causing serious harm to patients. A survey of physicians taken in December 2020 by the American Medical Association shows just how often prior auth delays occur.


Medical Billing Tax, Prior Auth, Telemedicine Hit Committee Hearings - 04/09/2021

The Senate Finance Committee is scheduled to take a look today at a bill that would protect billing companies from a tax currently scheduled to begin in October – and protect physicians and patients from any of those costs billing organizations pass on to them.


New Tools to Help Medicine Fight Prior Auth Hassles - 04/09/2021

TMA has created a prior auth social media toolkit that includes messages, sample posts, and articles that you can share on your personal or practice social media channels.


Legislative Hotline: Prior Auth for Chronic Disease Drugs Goes Before Insurance Panel - 03/16/2021

Two TMA physicians were scheduled to offer their perspective today to the House Insurance Committee on why the state should pass a bill that generally would bar prior authorizations for prescriptions for autoimmune and chronic diseases.


Streamlining Prior Authorization Burdens - 02/05/2021

Prior authorization of health care services has become a burden and a barrier to physicians providing the care their patients need. Health plans maintain they require prior authorizations to ensure requested services are medically necessary and appropriate. But the escalation of prior authorization use may also be motivated by a desire to control costs.


AMA Advocates for 24/7 Prior Authorization Processing - 11/19/2020

AMA delegates passed new policy on Tuesday that advocates for insurers and benefit managers who require prior authorization to have staff available to process  those approvals 24 hours a day, year-round, “including holidays and weekends.”


Mixed Bag: Some Payers Capitalize on COVID Chaos; Others Help Make Care Easier - 10/30/2020

Physicians believe some payers are taking advantage of COVID chaos with their drug policies, but also see some plans taking steps to make care easier during the pandemic.


Appropriate Use of Time? Medicare Rules for Advanced Imaging Orders Pose Prior-Auth Burdens - 04/09/2020

An effective way to cut down on overuse of potentially harmful imaging, or a prior authorization-esque burden on physicians who order needed tests? Texas physicians see Medicare’s “appropriate use” system for advanced imaging both ways. As of Jan. 1, physicians ordering advanced imaging tests for Medicare patients must consult an electronic portal, which evaluates whether the test meets Medicare’s own “appropriate use criteria” for whether a test should be ordered. Then when the claim is filed, physicians must document that they checked the system and its determination.  


Plans Should Inform Patients of Network Status When Requiring PA - 03/25/2019

When a patient is preauthorized to receive a health care service scheduled at a facility, the health plan should use the information submitted on the standardized prior authorization form to inform the patient of the network status of any physicians or health care providers who may be involved in the preauthorized health care. It also should be used to educate the patient on what level of coverage the health plan will provide and what the patient’s financial responsibility will be to all physicians and providers.


Medicine to Feds: Back Off Prior Authorization Requirements - 03/07/2019

The Texas Medical Association, American Medical Association, and a host of other medical societies are trying to stop onerous, care-impeding prior authorization requirements from overrunning Medicare Advantage plans.


Humana Peer-to-Peer Review Changing for Medicare Advantage Plans - 10/05/2018

Effective Aug. 1, Humana Medicare Advantage health plans will no longer offer peer to peer reviews after a medical necessity denial. Instead, the company will offer to schedule a peer-to-peer review before Humana issues the denial


TMA Delegates Push Back Against Preauth - 05/30/2018

The Texas Medical Association House of Delegates worked to recover the time and authority that insurance authorization and preauthorization requirements have increasingly taken from the state’s physicians.


U.S. Physicians Call Prior Authorizations An Overwhelming Burden - 04/12/2018

A nationwide survey released this week by the American Medical Association documents the growing, negative effects insurance companies’ prior authorization demands have on patients’ health and physicians’ time.


Facing More Hoops - 10/27/2017

Opioid abuse has killed tens of thousands of Americans in recent years, prompting health plans to adjust their prescription drug policies, including changing formularies and prior-authorization processes.