Prior Authorization Process Difficult – KFF Poll Results
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The process of obtaining prior authorization for healthcare services, treatments, and medications is a significant hurdle for many Americans, leading to frustration, delays, and even denials of necessary care. New data reveals that nearly half of individuals who have encountered prior authorization in the past two years found the process tough to navigate.
The Difficulty of Getting the Green Light
For a considerable portion of insured adults, the journey to get approval for medical needs is far from smooth. A recent analysis indicates that a significant number of people struggle with the administrative complexities of prior authorization.
A Challenging Process: Almost half (47%) of those who experienced a need for prior authorization in the past two years reported that it was either ”somewhat difficult” (34%) or “very difficult” (13%) to secure prior approval for a health care service, treatment, or needed medication.this highlights a widespread issue with the accessibility and understandability of the prior authorization system.
Delays and denials: The Cost of Waiting
beyond the difficulty of the process itself, many individuals face tangible consequences in the form of delayed or denied care. These outcomes can have a profound impact on a patient’s health and well-being.
Impact on Access to Care: Among all individuals who required prior authorization in the past two years,approximately half reported that their health insurance company either delayed their ability to obtain care (48%) or denied coverage outright (43%) for a service,treatment,or medication recommended by their doctor.
Broader Impact on Insured Adults: When looking at all insured adults, three in ten (29%) stated that their health insurance company has delayed or denied their access to a service, treatment, or medication that they or their doctor requested within the last two years.These statistics are consistent across different types of insurance plans.While administrative data may suggest a lower incidence of delays or denials compared to individual self-reports, perhaps due to initial denials that are later overturned or reporting discrepancies, the lived experience of many patients points to a clear pattern of delayed care.
Specialized Care Faces Greater Scrutiny
Certain types of medical services are more frequently subjected to prior authorization requirements, frequently enough leading to a higher likelihood of encountering delays and denials.
Services Requiring Prior Authorization: Services that commonly require prior authorization include surgeries, hospitalizations, imaging services, specialty drugs, specialized medical equipment, consultations with specialists, advanced laboratory testing, and mental health services. Individuals who have needed these types of specialized care report higher rates of prior authorization, delays, and denials.
* Experiences with Specialized care: Six in ten (62%) insured adults who needed at least one of these specialized care types reported being required to obtain prior authorization for a service, treatment, or medication in the past two years. Of this group, more than half (58%) experienced a delay or denial of their treatment, with 30% facing a delay and 27% experiencing a denial.
The persistent challenges associated with prior authorization underscore the need for greater transparency, efficiency, and patient-centered approaches within the healthcare system to ensure timely access to necessary medical care.