Most private and federal health insurance programs require prior authorization for certain treatments in order to reduce spending and avoid unnecessary care; however, the process may increasingly prevent patients from receiving the right care when they need it, The Lund Report reported Jan. 2.
Insurers argue prior authorization makes the healthcare system more efficient by cutting waste, but critics say it has become a tool to restrict or delay expensive care.
Cancer is one of the most expensive categories of disease to treat, according to the CDC. Here are three stats about how prior authorization affects cancer care:
- In 2019, patients spent more than $16 billion out of pocket on their cancer treatment, the National Cancer Institute found.
- A recent study found that major insurers issued "unnecessary" initial denials for imaging requests, most often in endocrine and gastrointestinal cancer cases.
- A KFF report found about 1 in 5 adults on Medicaid reported their insurers had denied or delayed prior approval for treatment, service, visits or drugs. This is double the rate of adults with Medicare.
The federal government is weighing reformed rules that would shorten the period insurers are permitted to consider prior authorization requests and require companies to provide more information when they issue a denial. At least 30 states have introduced legislation to address the issue.
Meanwhile, patients are taking to social media to shame their health insurance companies into approving prior authorization requests.