Prior Authorization Specialist
Prior authorization is a process used by health insurance companies to review the necessity of a medical treatment or medication before approving coverage. It has become a major burden for both physicians and patients.
Prior authorization is a process used by health insurance companies to review the necessity of a medical treatment or medication before approving coverage. It has become a major burden for both physicians and patients.
Insurance companies want to spend less money, and prior authorization is largely an effort to achieve this goal. However, it has been massively expanded in recent years, even to cover generic medications. This has led to a situation where a majority of prescriptions require prior authorization, complicating the decision-making process for both patients and physicians
Prior authorization is unpredictable, and the lists of drugs and procedures that require it are constantly changing. Inappropriate rejections are common, and the appeal processes are painfully slow and burdensome. This leads to frustration for both patients and physicians, who have to fight rejections and wait for responses from health insurance companies.
There are efforts to fix prior authorization, with the American Medical Association (AMA) working to right-size the process and reduce its administrative burden. The AMA has a recovery plan for America’s physicians, which includes tackling prior authorization with research, practice resources, and reform resources.
Physicians are just as frustrated as patients and are not the ones who set up the prior-authorization system. They are fighting on behalf of their patients to get them the medications and treatments they need.
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