Bring Transparency to Prior Authorization

TMA Testimony by Doug Curran, MD

House Insurance Committee
House Bill 2327 by Rep. Greg Bonnen, MD 

March 26, 2019

Thank you, Mr. Chairman and committee members, for allowing me to testify today. My name is Dr. Doug Curran. I am a family physician from Athens, Texas, and president of the Texas Medical Association. Today I am testifying on behalf of TMA and its nearly 53,000 members across the state of Texas in support of House Bill 2327.  

Prior authorization is a cost-saving tool that health insurance companies use. When a health plan requires prior authorization of a health care service, the physician must submit paperwork (prior to performing the service) so the health plan can review the medical necessity and appropriateness of the proposed service. Then, the health plan’s payment is conditioned upon the plan’s approval of the prior authorization request. 

Prior authorization is often very burdensome and can present a significant impediment to optimal patient care. It can cause delays in medically necessary care, which may detrimentally affect patient health and finances. Excessive prior authorization requirements also create administrative hassles for physicians and consume time that otherwise would be devoted to patient care. 

Patients and physicians would like to reduce the intrusive effect that prior authorization has on the patient-physician relationship so that the care that’s truly needed to keep Texans healthy can be provided in a timely, efficient manner.  

The American Medical Association recently released a few relevant statistics:

  • Ninety-one percent of physicians report delays in care due to prior authorization requirements.
  • Twenty-eight percent of physicians reported that prior authorization has led to a patient having a serious adverse event.
  • Seventy-five percent of physicians report that prior authorization can lead to patient treatment abandonment.
  • Ninety-one percent of physicians reported prior authorization creating a significant or somewhat negative impact to patient outcomes.
  • Eighty-six percent of physicians see prior authorization as a high or extremely high burden, and 88 percent say the burden of the process has increase significantly over the past five years.

These statistics have been provided to you along with real physician stories of the administrative hassles associated with prior authorization. HB 2327 would be a tremendous help to physicians in treating our patients when prior authorization is required for patients to obtain necessary medical care.   

HB 2327 would aid physicians and patients alike because it would make health plan prior authorization requirements more transparent. Knowing what the requirements are in advance of providing services helps us save time for our patients and our practice.  

Additionally, some physicians routinely have prior authorization requests approved by the health plan, yet they receive no relief from the continued administrative burden of the health plan’s prior authorization requirements. HB 2327 seeks to address this issue with an exemption so that physicians with a demonstrated approval record may focus more time on patient care.  

Insurance companies need to stop creating hurdles to maintaining the patient-physician relationship. Unquestionably, prior authorization is a significant hurdle. HB 2327 would not eliminate this hurdle altogether for all physicians and patients, but it would make the prior authorization process easier to navigate and make health plans more accountable for the processes they put in place. We believe HB 2327 will be highly beneficial for Texas patients and physicians alike. 

Thank you for your time and I am happy to answer any questions.  

86th Texas Legislature Letters and Testimonies

TMA Legislative main page

Last Updated On

March 25, 2019

Originally Published On

March 25, 2019

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