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Majority of physicians report treatment delays due to prior authorization

prior authorization

Ninety-four percent of physicians report care delays associated with insurance prior authorization requirements and 80% report that such advance treatment approvals have led to early treatment abandonment, according to the results of a survey released Monday by the American Medical Association.

The survey of 1,001 doctors conducted in December 2022 also found that 31% of physicians report that prior authorization criteria – many of which are in place due to state regulations or parameters set by individual insurers — are “rarely or never evidence-based.”

Regarding effectiveness, 33% of physicians report that prior authorization has led to “a serious adverse event” for a patient in their care, and 9% report it’s led to “permanent bodily damage/disability or death.”

Eighty-six percent of those surveyed said prior authorization leads to higher overall utilization of health care resources and 64% said authorization requests have led to “ineffective” initial treatments.

On average, physicians handle 45 prior authorization requests a week and reportedly spend two business days each week managing such requests; 35% report they have had to hire additional staff to exclusively handle administrative duties related to such requests.