Insurers’ Efforts to Curb Wasteful Spending Is Driving Doctors Nuts – By Lola Butcher (Mother Jones) / May 28, 2022
Some physicians think firms are using “prior authorization” as a lucrative delay tactic.
This story was originally published by Undark and is reproduced here as part of the Climate Desk collaboration.
Last December, a young patient was admitted to Nationwide Children’s Hospital in Columbus, Ohio, after several medications had failed to quell the child’s relentless seizures. A hospital pediatrician, Vignesh Doraiswamy, consulted with neurologists and then tried a different drug. The child had fewer seizures, became more interactive, and was ready to go back home, says Doraiswamy. But there was a problem: The patient’s insurance company refused to authorize the new medication for the parents to administer. The family had to remain in the hospital for at least two more days, Doraiswamy recalls, while the decision went through an appeals process.
Doctors have long asserted that prior authorization—the need to get approval from the patient’s insurer before proceeding with treatment—causes delays that can hurt patient care. In an American Medical Association survey conducted in December 2021, one-third of physicians reported that such delays have caused at least one of their patients to experience a serious problem, such as hospitalization, the development of a birth defect, disability, and even death. In that same survey, more than 80 percent of surveyed doctors said patients at least sometimes abandon their recommended treatment because of prior authorization hassles. Just over half of the physicians who treat adult patients in the workforce said prior authorization has interfered with patients’ ability to do their jobs.
Prior authorizations also exact a toll on doctors, who say the paperwork has gotten out of hand. The average physician must now seek approval for dozens of prescriptions and medical services each week, an administrative burden that contributes to burnout and costs physician practices an estimated $26.7 billion in time each year.
