Insurers are imposing huge administrative burdens on physicians, costing them time and money. Securing prior authorization from insurers is particularly costly. Some physicians are now shifting these costs onto their patients, reports Shannon Firth for MedPageToday.
Physicians are imposing additional charges on their patients in a range of ways. They might charge a fee for each prior authorization request or letter explaining the medical necessity of a procedure. Or, they might charge an annual administrative fee for these types of services. Or, they might require the patient to come in for an additional visit in order to complete the paperwork and charge for that visit.
Some of the physicians interviewed explained that they want their patients to understand that these administrative burdens are not their doing. It’s the insurers that are forcing them to spend additional time on this paperwork.
It is not legal for physicians to charge patients with Medicare and Medicaid additional amounts for handling prior authorization requests. If you have Medicare or Medicaid and your physician charges you for these administrative services, you should report the physician to the government.
The AMA reports that physicians must process about 40 prior authorization requests each week. That costs a lot. To protect their bottom lines, in some cases, physicians are moving to a concierge model and opting out of Medicare. They can then charge whatever they want for their services.
Last year, insurers promised to simplify the prior authorization process. But, doctors and patients are still feeling the pain. It would be far better if Congress stepped in and turned prior authorization over to an independent agency. Insurers should not control prior authorization; insurers have a financial incentive to use prior authorization whenever they can to maximize profits and have no reason to be concerned about administrative burdens on physicians or patients.
Here’s more from Just Care:
- Oncologists report excessive deaths from prior authorization
- Insurers misuse prior authorization even for simple treatments
- Is there a good alternative to prior authorization?
- New physician survey finds prior authorization harms cancer patients
- Medicare Advantage costs and prior authorization rules impede access to care
