Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ experience with insurance companies’ prior authorization requirements and approval processes.
According to preliminary results of the Texas Medical Association’s 2020 Physicians Survey, 96% of Texas physicians described the prior authorization process as burdensome, with 69% of that group calling the process “very burdensome.” In addition, 87% said burdens associated with prior authorization have increased over the past five years.
But this is more than a doctor’s office hassle. Patients are paying the price with their health.
In that same survey, 85% of physicians said prior-authorization issues have caused delays in patient access to necessary care, while 78% have had patients abandon their recommended course of treatment because of prior authorization requirements.
The TMA survey was taken in February 2020 before the COVID-19 pandemic became widespread in Texas.
Your personal stories of the impact of prior authorization requirements on your practice and patient care – including any patient harm due to prior authorization request delays or denials – can give TMA the ammunition it needs to fight this problem.
TMA made some progress with the passage of Senate Bill 1742 in 2019. The law requires state-regulated health plans to post any prior authorization requirements on the internet and opens the door for utilization reviews to be conducted earlier in the appeal process by a physician in the same or similar specialty as the physician requesting treatment approval.
TMA will continue to fight during the current legislative session for bills that will reduce prior authorization hassles and the delays in care they cause.
“Physicians already know all too well the burdens and harm that can occur when insurance company impose prior authorization requirements,” said TMA President Diana L. Fite, MD. “Our lawmakers need to do more to make sure our patients get the medicines, tests, and treatments that they need, when they need it.”
That’s where you come in. Nothing moves elected officials to action like a slew of real, serious complaints from constituents. As the 2021 Texas Legislature gets under way, TMA plans to collect and publicize prior authorization nightmare stories. We’ll “prime the pump” with stories physicians like you provide and use them to solicit more from the public directly.
Please submit your stories via TMA’s secure email portal. Before submitting your story to us, it is important for you to ensure that your story submission complies with state and federal laws, including, to the extent applicable, the HIPAA privacy rule. HIPAA’s safe harbor list of 18 de-identification requirements, in accordance with Code of Federal Regulations, is available here.