by Matt Eyles
September 12, 2018
In “The Insurer Will See You Now,” the writer mischaracterizes the purpose of prior authorization and how it works. Insurance providers use prior authorization under the supervision of medical professionals, promoting safe, timely, evidence-based, affordable and efficient care.
Prior authorization requires advance approval of coverage for a medical service. It’s applied to less than 15 percent of treatments. It may be applied to drugs or biologics with safety concerns, or that have less expensive alternatives. It can eliminate unnecessary tests—such as certain imaging tests that are commonly overused and may expose patients to potentially harmful radiation, undue surgical procedures or added stress. Prior authorization is also used to improve care coordination or reduce costs.
More competition, price transparency, and standardized processes will improve prior authorization. We are committed to working on solutions that are better for patients and consumers. Because better care is what it is all about.