AMA: Preauthorization Hurts Care

An American Medical Association survey of about 2,400 physicians finds significant difficulty in obtaining approval from insurers on treatment, which negatively affects patient care, according to the organization.


An American Medical Association survey of about 2,400 physicians finds significant difficulty in obtaining approval from insurers on treatment, which negatively affects patient care, according to the organization.

Seventy-eight percent of respondents believe insurers are using preauthorization requirements for an unreasonable list of tests, procedures and drugs, says James Rohack, M.D., immediate past president of the AMA. Survey results include:

* 37 percent of respondents experience a 20 percent rejection rate on first-time preauthorization requests for test and procedures, with 57 percent having a 20 percent rejection rate for first-time preauthorization of drugs;

* 46 percent have difficulty getting approval from insurers on 25 percent or more of preauthorization requests for tests and procedures, with 58 percent having the same problem with drugs;

* Almost two-thirds of respondent physicians often wait several days to receive preauthorization for tests and procedures, with 13 percent waiting more than a week, and the rates are higher for drugs;

* About two-thirds also say it is difficult to determine which tests, procedures and drugs require preauthorization; and

* 75 percent believe an automated preauthorization process would be more efficient.

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--Joseph Goedert