Eliminate Prior Auth for In-Network Physicians

TMA Testimony by Testimony by John Flores, MD

House Insurance Committee
House Bill 3232 by Rep. Julie Johnson
No Prior Auth. For In-Network Physicians

April 16, 2019

Thank you, Mr. Chairman and committee members, for allowing me to testify today. My name is Dr. John Flores, and I am an internal medicine physician from Carrollton. Today I am testifying on behalf of the Texas Medical Association and its nearly 53,000 members in support of House Bill 3232.  

Prior authorization is a cost-saving tool that health insurance companies use. When a health plan requires prior authorization of a health care service, it requires the physician to submit paperwork (before performing the service) so that 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. Prior authorization 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 Texans can receive the care they truly need to stay healthy in a timely, efficient manner.

The American Medical Association recently released a few statistics that demonstrate the negative effect prior authorization has on patients and physicians:

  • 91% of physicians reported delays in care due to prior authorization requirements.
  • 28% of physicians reported that prior authorization has led to a patient having a serious adverse event.
  • 75% of physicians reported that prior authorization can lead to patient treatment abandonment.
  • 91% of physicians reported prior authorization creating a significant or somewhat negative impact to patient outcomes.
  • 86% of physicians see prior authorization as a high or extremely high burden, and 88% say the burden of the process has increased significantly over the past five years.

HB 3232 recognizes the many negative effects of prior authorization requirements and seeks to prohibit prior authorization requirements if a patient seeks care from an in-network provider. The thought behind this is if a health plan trusts a physician enough to credential and put him or in the plan’s network for patients, it should also trust the physician’s medical judgment in seeking the best course of treatment for patients.

Thank you for allowing me to testify today, and I am happy to answer any questions.

Last Updated On

April 15, 2019

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