A new Biden administration rule released Wednesday aims to streamline the prior authorization process used by insurers to approve medical procedures and treatments.
Prior authorization is a common tool used by insurers but much maligned by doctors and patients, who say it’s often used to deny doctor-recommended care.
Under the final rule from the Centers for Medicare and Medicaid Services, health insurers participating in Medicare Advantage, Medicaid or the ObamaCare exchanges will need to respond to expedited prior authorization requests within 72 hours, and standard requests within seven calendar days.
The rule requires all impacted payers to include a specific reason for denying a prior authorization request. They will also be required to publicly report prior authorization metrics.
It gets better. So many times Dr’s will have to start with treatments they know won’t work because otherwise insurance will just decline it all together.
The funny part is that this the ends up costing the insurance companies more. Nose removed, face spited.
It may cost more for that individual, which is likely additive. What’s multiplicative is the number of people who don’t or can’t jump through the hoops and just move on. Having a tough time getting out of a subscription service? Insurance basically did it first.
Agreed, they play the numbers game but at the cost of human suffering. All the cases where it costs them more though is just illustrative of the stupidity of it and helps show that there is room for legislation to curb this.