Physicians Say Prior Authorization Fights Are Back

By Allison Bell

News April 08, 2021 at 09:00 AM

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Many physicians say health insurers pushed prior authorization requirements back up to normal, pre-pandemic levels this winter, as COVID-19 case counts and hospitalizations surged.

About 52% of the 1,000 physicians who participated in an American Medical Association survey reported that the health plans they work with have kept prior authorization requirements at the usual levels throughout the pandemic.

Another 17% said they believe health insurers did ease the requirements early on but have since returned prior authorization requirements to normal.

Health insurers assert that prior authorization processes can lower the cost of care and improve the quality, by protecting patients against unnecessary or overly expensive care.

Skeptical Docs

The AMA survey participants were skeptical about the value of insurers' prior authorization efforts.

The participating physicians are having to complete an average of about 40 prior authorization requests per week.

Only 15% of the physicians said they believe that health insurers' prior authorization criteria are based on evidence-based medicine, or on guidelines from national medical specialty societies.

Another 32% said they believe insurers' prior authorization criteria are rarely or never based evidence-based medicine or medical society guidelines.

Ninety percent of the physicians said prior authorization programs have no significant effect on care outcomes, but 9% said they do think the programs have hurt the quality of care for at least some patients, and 24% said they often or always see patients going against medical advice because of issues related to the prior authorization process.

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