February 27, 2024- Prior authorization is the process by which physicians must obtain advance approval for a device, supply or medication from the patient’s insurance plan to ensure coverage for the recommended service, per the American Academy of Family Physicians. And it’s making family physicians – and a lot of other people – angry.
Many physicians believe it makes the insurer the ultimate arbiter on what medical care should or should not be provided to their patients. They resent that practices must complete prior authorizations via multiple platforms, including web portals, electronic portals, electronic medical records systems, fax, paper forms, and phone calls.
Much of the fuss is due to Medicare Advantage plans. KFF (formerly called the Kaiser Family Foundation) reports that in 2021:
More than 35 million prior authorization requests were submitted to Medicare Advantage insurers.
Learn More in the latest issue of Repertoire Magazine.