For patients with even fairly straightforward medical problems, getting prior authorization for medical care is often a confusing and frustrating experience. Prior authorization is the insurance company process of requiring doctors to get approval before the insurer will pay for certain medications or treatments. The process is time-consuming and difficult to understand for both patients and their physicians.
You can imagine how that might feel as a patient – you need a critical medicine, procedure or diagnostic study, but are told that you have to wait for permission. You don’t know how long that permission might take to come, and you’re doctor can’t even say for sure whether it will be approved. In the meantime, all you can do is wait and hope.
In fact, there is evidence that this is exactly what does happen. According to a study done by the American Medical Association (AMA), 92 percent of physicians report care delays when a prior authorization is required by the patient’s health insurance company, and 61 percent report significant negative impacts on clinical outcomes for those patients (American Medical Associaion , 2017).
Thankfully, our Montana legislators are sticking up for patients and trying to fix this. Rep. Dennis Lenz, R-Billings, introduced House Bill 555 (HB555) and the first hearing in the House Human Services Committee was on Feb. 22. HB555 revises current Montana state law to make prior authorization more straightforward and reduce the waiting periods imposed by the insurance companies.
This is welcome news. Particularly in a state with a limited number of rural providers, we need to make sure that physician time is spent with patients – not on paperwork. The 2017 AMA study showed that doctors and their staff currently spend an average of 16.4 hours per week responding to prior authorization requests. That time does nothing to improve patient care or the health of our communities. The result is decreased time with patients, and burnout among our providers.
Prior authorization may save money for the insurance companies, at least up front. For this reason, it is doubtful that we will convince them to get rid of the process altogether. But, we should expect them to follow a timely and reasonable process that patients and providers can easily understand. That is exactly what HB 555 does, which is why the Montana Medical Association supports Rep. Lenz’s bill.
As physicians, we find greatest satisfaction in the time we spend with our patients – not the hours we spend on the phone with insurance companies. Likewise, patients gain most from the time they spend with their providers – not from the time their doctors spend on the phone. In this way, HB555 is a positive step forward for both patients and their physicians. Please join me in supporting HB 555, and asking your legislator to do the same.
Jason Cohen, MD, lives in Kalispell and is on the Legislative Affairs Committee of the Montana Medical Association.