Doctors and patients have raised concerns about whether some companies are putting up unnecessary hurdles or rejecting claims out of hand
It’s difficult to say whether insurance companies are truly getting stricter in deciding which medications they will pay for, or if doctors and patients are simply noticing it more and drawing greater attention to the issue. Afound about 33% said they knew of a case where a patient’s health deteriorated while waiting for prior authorization, and 64% said at least some patients had to first try a treatment that didn’t work for them.
“This is to ensure the therapies we cover for our members are safe, effective and evidence-based,” she said in a statement. “If a member has a concern about a coverage decision, we always encourage them to take advantage of their rights to appeal.”David Allen, a spokesman for America’s Health Insurance Plans, said prior authorization is one way companies protect their customers from receiving care that isn’t safe or hasn’t been shown to work.
Dr. Patrick Pevoto, president of the Colorado Medical Society, said he understands the need for some checks on prescribing, since not all doctors have good intentions. But as is, the demands of prior authorizations add costs to the system, because practices have to hire someone to manage the paperwork, and long delays sometimes lead patients to stop trying to get necessary treatment, he said.
“If the majority of doctors are doing the right thing, let it happen,” he said. “Let patients get the care they need.”
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