U.S. Physicians Call Prior Authorizations An Overwhelming Burden
By David Doolittle

Prior_authorization

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.

According to the survey, conducted in December, 92 percent of physicians said prior authorizations caused delays in care. That’s almost on par with the AMA’s 2016 survey in which 90 percent of physicians reported delays.

In addition, 84 percent of physicians said the burdens associated with prior authorization were high or extremely high, compared with 75 percent in 2016.

The 2017 survey, which examined the experiences of 1,000 patient care physicians, also found: 

  • 92 percent say prior authorizations program have a negative impact on patient clinical outcomes; 
  • 86 percent believe burdens associated with prior authorization have increased during the past five years;
  • 78 percent said patients have abandoned treatments because of prior authorizations;
  • 64 percent reported waiting at least one business day for prior authorization decisions from insurers; and
  • 30 percent said they’ve wait three business days or longer. 

Prior authorizations are designed to keep costs down, but physicians tell the Texas Medical Association that in the past year or so, the requirements have become abusive.

TMA has worked aggressively to remove some of the associated burdens.

Thanks to TMA advocacy, Blue Cross Blue Shield of Texas announced in January that it will no longer require prior authorization for outpatient surgery in an office setting for several Employees Retirement System (ERS) of Texas plans.

TMA also worked diligently during the 2017 legislative session to limit health plans' role in treatment decisions in Texas.

The September issue of TMA’s Texas Medicine magazine took a hard look into prior authorizations, including independent review organizations and peer-to-peer conversations.


Last Updated On

April 12, 2018

Related Content

Insurance | Preauthorization

David Doolittle

Editor

(512) 370-1385

Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

More stories by David Doolittle