Patients and Physicians Speak Out

[Prior authorization affects my practice because] it delays patient care. The process is tedious, and the insurance companies are programmed to deny first. You are on the phone for hours waiting and when you finally reach someone, they often redirect you to another department or team where you have to wait again. The operators don't know or understand the procedure or what the patient needs to authorize something. They also can't answer your questions because they are not clinical. The insurance companies have hard and fast rules that do not take the patient into account. They will still deny procedures even when their own medical experts agree with your assessment and what the patient needs. "If the plan doesn't cover it, then there's nothing they can do." The entire process is burdensome and harms patient care.

I have one dedicated staff member who has primary responsibility for all prior authorizations. From an 8-hour work day she dedicates 6 of them to prior authorizations. This is uncompensated care. Written prior authorizations most recently have increased in the number of pages that have to be filled out. We actually have prior authorizations pending with a total of 119 pages. Valuable time is spent away from patient care. What is most obnoxious is that there is no medical rationale in demanding the prior authorization…Frequently, there is no point of contact that can make a medical decision on the other end of the phone…Standard of care is affected by this entire egregious process…I could go on, but at this point it feels like a no-win situation where you are forced to submit to the demands of the pharmacy benefit manager.