Your physician knows the best treatment for you. Unfortunately, they’re not always the ones making the final decision. Instead, a process called prior authorization is used to deny or approve treatment prescribed by your physician. Why is approval needed if your physician prescribed the treatment and you’re paying for a health insurance plan that covers it?
Prior authorization forces your physician to contact your insurance company or a pharmacy benefit manager to get approval before you can start certain treatments. Your treatment can be delayed anywhere from a few hours to a few weeks as insurers review the request. *
Prior authorization makes it harder to deliver quality care. Your physician and their staff spend hours submitting paperwork and calling insurers trying to secure approval while you wait for treatment. Some patients, frustrated with the wait and confusing process, abandon their treatment.
Prior authorization can also lead to serious adverse events, including hospitalization, disability, or even death.*