Doctors and patients complain that the controversial practice of prior authorization for treatment and procedures is still widespread.
Nearly a year after the nation’s health insurers pledged to overhaul their much-criticized practice of prior approval for medical care, patients and doctors say there is little evidence that delays and denials for necessary treatment have eased.
Just ask Candace Rond. She tried for weeks to get medication for her 15-year-old daughter, Gabby, who has two autoimmune diseases.
“The whole prior authorization experience is a nightmare,” Ms. Rond said.
In January, Ms. Rond was told she could not refill her daughter’s prescription until the insurer reviewed the request. Gabby was in pain, and Ms. Rond worried that her daughter’s sophomore year of high school would suffer. “I just get so frustrated,” Ms. Rond said.
About two months later, after repeatedly checking, Ms. Rond, who is a volunteer in Utah for the Arthritis Foundation, was finally able to refill the prescription. She is dreading this summer, when her insurance coverage begins a new year and a new approval cycle for her daughter’s medication.
Insurers’ use of prior authorization has generated significant public outrage, as has the budgetary stress caused by the rising costs of health care. In a recent poll conducted by KFF, a health research organization, one of three adults with insurance surveyed said prior authorization was a “major burden,” with nearly 70 percent describing it as at least somewhat burdensome.
Last June, dozens of insurance companies voluntarily promised to reduce the number of tests and procedures requiring prior approval and to make sure patients could stay on the same treatment for 90 days even if they switched plans, according to a joint announcement by the industry’s two major trade groups. They also vowed to speed up the reviews.