Problem: Insurance health care authorization

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February 14, 2020
Dear editor;

Charles Darwin wrote that “A man who dares to waste one hour of life has not discovered the value of life.”

No one knows the truth of this better than someone struggling with a serious illness, for whom every hour of life is hard-won. But all too often, sick persons seeking medical care in Illinois must endure delays and denials. The culprit? Prior authorization approval requirements imposed by their health insurance plans.

Prior authorization means that health professionals must jump through extra hoops to get permission from payers to provide the care they believe their patients need.

This used to be a process that was used to prevent over-utilization of unnecessary testing. It’s now not functioning that way. It has become a cost management tool used by the insurance industry to reduce their cost, or delay the payments they know they eventually will have to make.

We doctors are used to complexity and no strangers to paperwork, but any physician will tell you that prior authorization is one of the most frustrating parts of practicing medicine these days. A 2019 survey of more than 1,000 physicians conducted by the Illinois State Medical Society confirms; nearly every respondent described a cumbersome, confusing, time-consuming, expensive process that lacks transparency.

More importantly, 95% of Illinois doctors reported that prior authorization harms their patients. Delaying medical care can allow diseases to progress, resulting in worse outcomes and making patients suffer unnecessarily.

Our patients should be spending their time fighting their illnesses and living their lives, not waiting to find out whether their health insurance plan will allow them to do so.

Illinois physicians understand that your care can’t wait, and it’s time insurance companies understood this too. Common-sense reforms are needed to bring transparency, fairness, and simplicity to prior authorization policies.

Together, we can fix prior authorization and make it work for our patients, friends, and neighbors. It’s about time.

Paul E. Pedersen, MD, president, Illinois, State Medical Society, Bloomington

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