Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Prior authorization reform for health care coverage takes center stage

Afua Aning, MD
Policy
July 23, 2021
118 Shares
Share
Tweet
Share

One of the leading reasons for provider frustration is prior authorizations. The insurance companies initially created prior authorization (prior auth) to keep down the cost of care when a service fee was the primary payment method for payers. However, it has become a hindrance for providers and staff as they spend hours waiting for authorization to provide medical care.

In the past, hospital organizations needed approval (prior authorization) from an insurance company before a medical professional could prescribe medication or perform a procedure. This process can be very time-consuming, costly, and inefficient. As a result, many patients are denied multiple times the needed medical treatment and care.

Another complaint is the lack of transparency from the payer regarding approving or denying the request. Physicians have found that the person supporting the authorization often does not have the necessary education or experience to decide what is best for the patient.

Reform of the current system is needed to increase provider satisfaction. If this occurred, there would be a dramatic reduction in red tape and lead to uniform measures for authorization to be shared between cooperating practitioners. Prior authorization reform ensures that routine procedures are pushed through faster, reducing medical care delays and improving clinical outcomes.

Reform ideas are beginning to move from a concept into state law. Texas Governor Greg Abbott allowed House Bill 3459 to go into law without his signature. Effective September 1, 2021. This bill has dissolved the dysfunctional prior-auth structure that has plagued health care for many years. In doing so, Texas has set an example for the nation to follow. I had the chance to speak with Lilly Timon; she is part of a grassroots organization that seeks to empower individuals to fight against the corporatization of health care and put patient care and safety ahead of profits. She galvanized and helped push the Texas bill through. She states that the legislation eliminates time-suck and improves the quality of care for patients.

The bill requires insurers to notify a physician or provider that they qualify for exemption from needing a prior authorization, which services the exemption applies to, and how long the exemption will last. The bill allows providers who have established 80 percent insurers-approved prior-auth in a calendar year to be exempt from rigorous requirements for the following calendar year.

After the law goes into effect, Texas health insurance companies have to be compliant with providers. The dilemma is now that the legislation passed, what will be the impact of making such a change?

If insurance companies refuse to make the necessary changes to comply with the law, who will enforce compliance, and what will be the consequence of not following the law? There still needs to be health care advocates for the push for insurance to comply. Advocates for such reform still need to work diligently. Another avenue is for health care organizations to join forces and take legal actions to make insurance companies compliant with the law. Otherwise, insurance companies will continue driving up costs while adding little or no value.

The new Texas law may serve as an example to the rest of the nation on beginning health insurance reform. The process has been long, but if the outcome is a more streamlined process that does not increase costs, legislators may duplicate the law in other states.

Afua Aning is a physician informaticist.

Image credit: Shutterstock.com

Prev

How a homeless teen became a physician [PODCAST]

July 22, 2021 Kevin 0
…
Next

Is Open Notes as good in practice as it is in theory?

July 23, 2021 Kevin 1
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
How a homeless teen became a physician [PODCAST]
Next Post >
Is Open Notes as good in practice as it is in theory?

More by Afua Aning, MD

  • The artistic side of a broken pot: a story about Oracle and Cerner

    Afua Aning, MD
  • Do prescription drug monitoring programs hurt more than they help?

    Afua Aning, MD
  • Physician informatics demystified

    Afua Aning, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • A history of health care reform

    Behrouz Zand, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Health care reform: America really is different from most other countries

    Suneel Dhand, MD
  • Health care reform: A free-market solution works in other countries

    Kent Holtorf, MD
  • Why health care replaced physician care

    Michael Weiss, MD

More in Policy

  • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

    Ton La, Jr., MD, JD
  • Why the WHO’s pandemic accord is critical for global health care

    Elizabeth Métraux
  • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

    Robert Pearl, MD
  • Unveiling the intricate link between housing costs and health care

    Harvey Castro, MD, MBA
  • Uncovering the truth about racial health inequities in America: a book review

    John Paul Mikhaiel, MD
  • Why affirmative action is crucial for health equity and social justice in medicine

    Katrina Gipson, MD, MPH
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

      Veronica Bonales, MD | Physician
    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • New Antiviral Option for CMV Prophylaxis After Kidney Transplant
  • Infant RSV Vax Heads to FDA for Review
  • Is Getting Test Results Online Right Away a Good Idea? Yes, Patients Say
  • Residency Application System Cuts Section on Hobbies and Interests
  • Workplace Harassment, Cyber Incivility High for Minority Groups in Academic Medicine

Meeting Coverage

  • Phase II Study: Bispecific Oral Drug Tops Leading JAK Inhibitor for RA
  • Closing the Diversity Gaps in Urologic Oncology Leadership
  • Certain NSCLC Patients May Be Able to Stop Immunotherapy at 2 Years
  • No Survival Benefit With Immune Checkpoint Inhibitor Rechallenge in Metastatic RCC
  • Happy Sleep, Happy Couple?
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

      Veronica Bonales, MD | Physician
    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Prior authorization reform for health care coverage takes center stage
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...