April 05, 2022
Insurance company prior authorization red tape creates serious and dangerous delays in care for many California patients.
According to a recent American Medical Association (AMA) survey, physicians and their staff spend an average of almost two business days (13 hours) each week completing an average of 41 prior authorization requests, resulting in a huge waste of health care dollars. Prior authorization also negatively impacts patients with 93% of physicians reporting that the process delays patient care, and more than four in five physicians (82%) said patients abandon treatment due to authorization struggles with health plans/insurers.
The California Medical Association (CMA) is sponsoring SB 250 (Pan) to require health plans to exempt physicians from prior authorization rules if they have practiced within the plan's criteria 80% of the time. All other physicians will have the right under the bill for a prior authorization appeal to be conducted by a physician in the same or similar specialty.
CMA is also working to introduce federal legislation modeled after California’s SB 250 and is supporting HR 3173, the “Seniors Timely Access to Care Act,” (Rep Bera), which would require Medicare Advantage plans to establish an electronic prior authorization process that provides “real-time decisions” for services that are routinely approved, publicly report to the U.S. Department of Health and Human Services, the rate of prior authorization approval or denials and adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.
CMA is asking you to share your unique experience as a patient, physician or health care professional so that we can best explain to lawmakers how prior authorization policies are harming patients.
If you have waited days or months for an insurance company to approve a medicine prescribed by your doctor, we want to hear from you. If you are a physician frustrated with the administrative headaches and their impact on your patient, we want to know your story.
Click here to share your prior authorization stories.