Another look at prior authorization
January 28, 2024
KFF Health News published a follow-up article on a patient's frustration with the practice of prior authorization. The article gives the background that "Prior authorization was conceived decades ago to rein in health care costs by eliminating duplicative and ineffective treatment. Not only does overtreatment waste billions of dollars every year, but doctors acknowledge it also potentially harms patients." However, the practice can also be abused to the benefit of insurers by denying legitimate medical care. Unfortunately, it seems that patients have little recourse when denied medical care, other than to appeal to the court of public opinion.
KFF Health News had previously reported on the federal government's effort to reform the practice, in part by reducing the time that insurers have to respond to prior authorization requests. However, it seems that there should probably be an independent agency or panel which includes medical expertise to help adjudicate differences in opinion on what constitutes legitimate medical care.