MedPage Today reports on a poll finding that prior authorization requirements in managed care plans, such as Medicare Advantage, lead to patients needing hospitalization, becoming disabled or dying, according to one in three physicians. Why does Medicare allow prior authorization–with its often unjustified barriers to care–in Medicare Advantage plans?
No one can deny that sometimes people get care that they don’t need. But, what makes health insurers able to determine what care is needed? On what do they base their decisions?
As a general rule, health insurers are not held to account for their prior authorization policies. Yet, this AMA survey found that three in ten physicians say that health insurers rarely if ever use prior authorization criteria that is evidence-based. And, 91 percent of physicians say that insurer prior authorization criteria have a negative impact on their patients’ health outcomes.
Almost one in five physicians (18 percent) said that an insurer’s prior authorization requirement resulted in a life-threatening event for a patient or a health outcome that “required intervention to prevent permanent impairment or damage.” On top of that one in 12 physicians said that their patients became disabled or physically harmed or died as a result of prior authorization requirements.
Congresswoman Suzan DelBene of Washington State has a bill, Improving Seniors” Timely Access to Care Act, intended to standardize prior authorization programs in Medicare Advantage plans. It would require health plans to disclose their requirements and greater oversight of them.
Some states limit or have introduced bills to limit insurers from using prior authorization, including New York, Texas, Illinois and Indiana.
More than 1,000 practicing physicians completed the survey.
Here’s more from Just Care:
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Well-kept secrets of Medicare Advantage plans
- Traditional Medicare offers better home care benefits than Medicare Advantage
- Medicare Advantage: Tune out the Joe Namath ads
- Don’t judge a Medicare Advantage plan by its stars
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