What You Need to Know
- One-third of the survey participants question the clinical validity of insurers’ prior authorization programs.
- Nine percent of physicians say prior authorization hurts patients’ care.
- Physician practices average 40 prior authorizations per physician per week.
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.
The AMA survey participants were skeptical about the value of insurers’ prior authorization efforts.