A new survey from the American Society of Radiation Oncology illustrates the dangers of prior authorization. Prior authorization kills an “inordinate number” of people and harms others. Insurers often deny care to the detriment of patients when physicians first ask for authorization; when denials are appealed, insurers then approve care the vast majority of the time.
About 225 of the 750 radiation oncologists polled reported adverse health outcomes from prior authorization. Their patients ended up in the emergency room or hospitalized or with a permanent disability. One in fourteen of the oncologists polled said that one or more of their patients had died as a result of prior authorization.
Prior authorization can have benefits, particularly in cases in which physicians are not well trained. Prior authorization can ensure physicians are treating patients appropriately, based on evidence. Prior authorization can also keep costs down.
But, insurers use prior authorization without regard to its effects on quality of life for patients. And, while prior authorization can help protect against unnecessary treatment, there is no one protecting patients from insurers that use prior authorization inappropriately, in ways that harm patients.
The oncologists polled suggested insurers’ use of prior authorization is only increasing. Moreover, it increases staff burnout.
- More than nine in ten oncologists (92 percent) reported treatment delays from prior authorization and nearly seven in ten (68 percent) reported delays of at least 5 days;
- More than eight in ten oncologists (82 percent) blamed prior authorization for patients receiving less than the best care;
- Nearly six in ten (58 percent) oncologists said prior authorization kept them from following recommended guidelines;
Those polled made clear that it’s critical to appeal prior authorization denials because more than 70 percent are reversed on appeal. But, patients and physicians sometimes do not have the resources to appeal. In some instances, the tradeoffs of appealing care denials, in terms of time spent, means physicians are unable to do their jobs.
Moreover, insurers still have 72 hours to review an expedited appeal. For some patients with health insurance, the harm from such a delay is significant. One doctor said that in that time, “I’ve had patients who’ve literally had a tumor growing out of their chest. Waiting 3 days for an appeal means there’s more cancer to treat, even just in the time between when I made the plan for them initially, and when I actually get to start their treatment. Sometimes it means the plan has to change because the tumor has gotten that much bigger in that time period. Every day matters.”
Insurers shouldn’t be allowed to continue doing prior authorization for treatments that are virtually always approved on appeal.
Here’s more from Just Care:
- New physician survey finds prior authorization harms cancer patients
- Lower income Medicare cancer patients less likely to get optimal care
- Medicare Advantage insurers increasingly use step therapy for cancer drugs, delaying care
- Should you be screened for prostate cancer?
- Cancer screenings bring benefits at substantial cost
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