US lawmakers eye health insurance reform as frustrations mount [View all]
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Source: The Guardian
Tue 31 Dec 2024 12.02 EST
Last modified on Tue 31 Dec 2024 19.04 EST
In the wake of the killing of Brian Thompson, the CEO of UnitedHealthcare, and the outpouring of frustration about insurance coverage, prior authorizations have emerged as a particular roadblock in healthcare. Prior authorization requires medical providers to get an insurer’s approval before patients receive healthcare or medications.
“As a physician, prior authorization is the number one frustrating thing of practicing outpatient medicine right now, far and away,” said Dr Gabriel Bosslet, a pulmonologist and professor at Indiana University School of Medicine. “I spend more time trying to figure out how I need to get this medication approved than I do seeing the patient and making a diagnosis and writing the prescription.”
Originally intended to control the costs of certain medications and treatments, the frequency of prior authorization requirements has risen in recent years and they now plague common and inexpensive care. “This didn’t really happen five or seven years ago,” Bosslet said.
Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh, noted that “prior authorization is something that really proliferated with the growth of managed care in the United States”. One study found reforms such as setting maximum time periods for insurers to respond and standardizing requests would help give patients needed care. Several states and Washington DC have passed laws to reform prior authorization practices.
Read more: https://www.theguardian.com/us-news/2024/dec/31/health-insurance-prior-authorization
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