Health professionals say prior authorization can waste valuable time

Health

HARRISBURG, Pa. (WHTM) — Dealing with medical issues is hard enough. Having to go through a lengthy approval process before getting treated — can make it worse.

Patient advocates feel sometimes insurance companies demand too much.

Health care professionals and patients who’ve dealt with the consequences of delays from prior authorization are begging lawmakers for help — and they’ve got support.

Prior authorization started as a way to, in theory, control costs for experimental or new procedures.

It requires doctors to get approval from insurers before prescribing medication or moving forward with treatment and invasive testing.

But in practice “it makes the patients and doctors go through hoops, oftentimes for routine patient care,” said Dr. Song.

Health professionals say the red tape associated with prior authorization wastes valuable time.

A doctor shared a story of how it took three years to get an MRI for a suspected cancer case.

“That MRI detected pancreatic cancer that failed to be detected by any other means of testing,” said Dr. Tiffany Leonard. “Despite aggressive treatment, the patient died several months later. There is little doubt if that diagnoses had been identified three years prior, their outcome could have been significantly different.”

If House and Senate Bills 225 pass, the legislation would curb restrictive prior authorization and stop so-called “fail first” practices imposed by health insurers.

Doctors say this isn’t about cutting corners — it’s about common sense.

“They are not trying to get rid of prior authorization all together,” said Dr. song. “There are things that need to be vetted that way. It is trying to make a logical and less frustrating and time consuming for everybody.”

She adds the bills have bipartisan support, and she is optimistic the governor would sign it. abc27 News reached out to the governor’s office and was told the administration is still reviewing the bill.

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