I recently had a front-row seat to how the health insurance industry is doing on its pledge to “streamline” prior authorization. Spoiler alert: it looked a lot more like the fox guarding the hen house.
When my gastroenterologist ordered an MRI/MRCP, I anticipated delays. Two months later – after navigating insurance denials, medical policies that contradict national guidelines, and countless phone calls – I finally got a date for the scan.
Significant delays and denials remain the norm for patients and physicians. The timeline to navigate the authorization process and obtain necessary test or treatments is often weeks to months (not the 7–14-day turnaround time conveniently touted by insurers and regulators, since that clock doesn’t even start until insurers (self) determine they “enough” info).
Current reforms – whether AHIP’s voluntary pledges or CMS programs like WISeR – don’t address the root problem. Prior authorization should be the exception, not the rule. Expanding it in traditional Medicare makes sense only for those who profit from it.
Instead, we need systems and technology designed around patients with the goal of optimizing access, experience, and affordability. Until then, prior authorization remains a tool to delay and deny care, not to protect it.
See link to my latest piece in Healthcare Uncovered in first comment below.
