Prior authorization is, simply, the process of getting approval from an insurance company for a healthcare service. This can be anything from a prescription being filled to a surgery. It’s something which is meant to save insurance companies time and money. However it is also something which does inhibit patient care and, at times, cost. 

What’s frustrating about this process is, above all else, the way it has become bottlenecked. Submitting and getting word back on prior authorization can take days, weeks, or even months. This is made problematic when 27% of physicians say prior authorization is often or always denied. Even worse, many physicians don’t find the criteria for prior authorization rejection to be explicitly evidence-based.

Most healthcare providers are already extremely overworked, and nearly half don’t have the time to appeal rejections to their submission. What this means is that if prior authorization doesn’t go through, their patient can’t get affordable care. Many physicians opt to hire staff explicitly for prior authorization requests, but this isn’t always affordable or realistic.

Fortunately, there are some modern solutions to this problem, such as automating the submission process. AI software can find patient files, call insurance companies, and appeal rejections. This saves countless hours and doesn’t require hiring staff explicitly for the job. However these services are still being developed, and still require human oversight. 

Other paths to easing these frustrations are reducing the necessity of prior authorization increasing ease of submission. If prior authorization is going to be required, it needs to be easy, clear, and quick. If it’s not, then alternative systems should be developed such as prior authorization process automation. These are the modern frustration of prior authorization. Providers and patients alike aren’t happy with the system, but that doesn’t mean there aren’t ways to ease the burden.

Source: Orbit Healthcare