Prior Authoriza Ɵ on Health plans tout prior authoriza Ɵ on (PA) as a cost-saving measure, but they may not be disclosing
the full consequences of PA on your well-being. When you need medical care, you turn to your physician. Unfortunately, PA requirements force physicians to contact the health plan or pharmacy bene fi t manager to get approval for certain treatments before they can administer care. You can wait days, weeks, or even months for approval. Result? Your health su ff ers, poten Ɵ ally leading you to take sick days or being less produc Ɵ ve while at work and home. Adding to the confusion for pa Ɵ ents like yourself is the reality that the unknown face denying your care is more o Ō en than not an individual without medical training , such as a nurse, a pharmacist or a therapist. Your physician must then spend addi Ɵ onal Ɵ me fi gh Ɵ ng your insurance company to give you the care you’ve paid for and need.
Sta Ɵ s Ɵ cs quoted are from the 2021 American Medical Associa Ɵ on Prior Authoriza Ɵ on Physician Survey.
Among the 91% of surveyed physicians who treat pa Ɵ ents between the ages of 18 and 65 and currently in the workforce, more than half (51%) report that PA has interfered with a pa Ɵ ent's ability to perform his or her job responsibili Ɵ es. At the end of the day, PA isn’t “cheap” when it interferes with maintaining a healthy, produc Ɵ ve lifestyle. The care delays, abandonment, and denials related to PA can lead to signi fi cant nega Ɵ ve clinical outcomes for everyone. In fact, over one-third (34%) of physicians report that PA has led to a serious adverse event, such as hospitaliza Ɵ on, disability, or even death, for a pa Ɵ ent in their care. PA can prevent you from being able to use the bene fi ts already paid for via subsidies and premiums. What is the value of health care bene fi ts if you can’t receive Ɵ mely care—or are forced to pay for treatments out of pocket? Health plans agreed to make changes to improve the PA process several years ago, but surveyed physicians report sluggish progress on these reforms. Now is the Ɵ me for pa Ɵ ents, employers and regulators to demand transparency from health plans on the growing impact of prior authoriza Ɵ ons.
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