By Lauren Johnson
Insurance companies have been gradually expanding the use of prior authorizations for routine medical care, which is bogging down physicians with paperwork and delaying care for patients.
Amanda Williams, MD, president of the Medical Association of the State of Alabama and a psychiatrist at Gardenia Cove Mental Health in Montgomery, is hoping insurance companies will hear their requests to improve the process and create a sensible system.
“We’re trying to come up with all these different ways to make the practice of medicine more sustainable,” Williams said. “We’ve had so many physicians burning out. Alabama has a huge workforce shortage of physicians, so we’re trying to do anything we can to make it more rewarding and fulfilling to be a physician. Most people didn’t go into medicine to fill out a bunch of paperwork and fight with insurance companies to get a patient what they need.”
Prior authorization started as a requirement for rare or expensive treatments, but now it’s required for almost anything that the insurance company could pay for, including medical procedures, medications, diagnostic tests, surgeries, follow-up care, and more. This time-consuming process slows everything down, causing frustration for patients and physicians.
“The more insurance companies deny and put roadblocks up, the less likely it’s going to be for them to have to pay for these things. I have multiple patients who have given up on it and paid cash for some of their medications because they need them and they don’t feel like fighting with their insurance company anymore,” Williams said.
Williams found a survey that reported one-third of Alabama doctors spend almost an entire workday each week filling out prior authorization paperwork, following up with phone calls and fighting denials. This leaves doctors with less time to see patients.
“It’s a nationwide issue,” Williams said. “Obviously, every region and every state has their own particular problems, but for Alabama physicians, this has come up over and over again as one of the key frustrations in the practice of medicine.”
Right now, the system is redundant and creates more hoops for physicians to jump through to provide medical care to patients. If the prior authorization is automatically denied, there is an appeal process that involves more paperwork and sometimes doctors must redo forms they’ve already filled out.
“Even once they’ve been approved, especially for chronic conditions, you have to repeat the prior authorization again,” Williams said.
If a patient changes insurance companies or if an insurance company changes their policy, there can be a gap in care while doctors redo the paperwork again to get it approved.
“Some of the things that they’re requiring prior authorization for are cheap. It’ll be a medication that, if you pay with GoodRx, you can get it for next to nothing, and we’re still having to spend all this time to do a prior authorization,” Willaims said. “Some of it’s just a waste of healthcare dollars, on their end and on our end.”
In this new campaign, physicians are asking for timely responses, within 24 hours for urgent cases and within 48 hours for less urgent cases. They’re asking to remove the repetition of prior authorizations for patients with chronic conditions. If something is approved, they ask that the insurance company not change the decision later to a denial.
They’re asking for all the forms to be electronic, removing the excess paper and the use of fax machines. They’d also like the insurance companies to publicly report the data of approvals versus denials, and if something is denied, they’d like to have a peer-to-peer evaluation with someone who has clinical knowledge of the treatment or medication that is being discussed. Williams believes these changes will ease the administrative burden and make the process less painful for everyone.
“In the midst of this workforce crisis, we’re trying to figure out all the different ways that we can reduce the burdens of healthcare, anything we can do to prevent physicians from either retiring early or decreasing their clinical hours,” Williams said.
To address this issue, she and her team are gathering patient stories and physician stories about their experiences with prior authorization to bring to the insurance companies and leaders across the state. If you have experienced delays in care or if you couldn’t receive treatment because of prior authorization, visit the website www.ALFixPriorAuth.com to share your story.