Prior authorization is the process of a healthcare provider submitting a request for the insurance to cover a service. While the physician may believe they know the best drug or treatment option, the insurance company won’t always agree. This has led to strain and tension in the past. 35% of physicians don’t believe that the criteria used by insurance companies is evidence-based. Three fours of physicians say denials are becoming more common with time.
The implications of this can be worrying. Already, in the worst cases, it can take months for a prior authorization request to go through. However in the case that the request is rejected, submitting an appeal pushes the timeline back even further. For patients, this means more and more time goes by where care cannot occur. Of course, patients can technically pay out of pocket, but that’s almost never realistic.
Existing under this reality, new solutions have to be strived for. While streamlining prior authorization submission would be great, it also is challenging. Instead one prominent solution has been the automation of the submission process itself. This doesn’t inherently make it easier, patient files have to be collected, insurance companies called, etc. However it does make it so that the strain on healthcare providers is lessened.
Reducing this strain ensures that proper care can continue, and that the already overworked healthcare industry can continue to function. Primarily this automation has come through the use of prior authorization process automation. These services have the power to collect the information and properly submit complex requests. They also can respond actively to rejections by submitting appeals. It doesn’t solve the issue, but it reduces the time to treatment and strain on providers.
Source: Orbit Healthcare
