MONTGOMERY, Ala. — A total of 30 medical groups Alabama State Medical Association In an effort to push for reform of health insurance preauthorization requirements, the group argues that it would lead to problems such as: Increase in medical costs, worsening of the disease or death.
This initiative is supported by MASA’sModify pre-approval” campaign was launched last August to address delays in treatment, services and medications by health insurance providers.
“We can no longer allow red tape and red tape to get in the way of effective medical care,” William Kilgo, director of USA Health in Mobile’s neuroimmunology and MS clinic, said in a statement. “Patients like me deserve better treatment.”
According to 2023 survey According to the American Medical Association, 94% of doctors said that prior authorization, a process that requires doctors to receive health insurance company approval before providing medical services, has delayed patient care. Of the 1,000 physicians surveyed, 24% reported that delays in prior authorization directly harmed patients.
MASA President Amanda Williams, a Montgomery-based psychiatrist, told the Alabama Daily News that responding to prior authorizations often takes up one-fifth of her workday, delaying treatment. He said it happens often.
“I wrote a cheap generic drug for a patient to take one and a half pills, but the insurance company didn’t want to pay more than one pill a day for this drug. What would it cover? It’s a waste of the patient’s time, and it’s a waste of my time,” Williams told ADN.
“Those things happen all day, every day, and they’re just routine tasks. And then when you have patients who need hospitalization or need certain medications urgently, and those are delayed; Something more serious will happen.”
As part of the campaign, MASA has outlined 11 specific policy reforms it is advocating for health insurance companies to consider implementing. These include prohibiting repeated prior authorizations for patients with chronic conditions, prohibiting retroactive denials after prior authorization approval, and requiring annual publication of relevant data. Prior Approval Refusal and Approval.
The group is also advocating for health insurance companies to mandate response times for prior authorization requests within 24 hours for emergency care and 48 hours for non-emergency care. Current state law only requires health insurance providers to comply with prior authorization requests. within 2 business daysregardless of whether the treatment is urgent or not.
Another policy reform advocated by MASA is to ban the sole use of artificial intelligence in initial pre-approval decisions. This is becoming increasingly common among health insurance companies. US Senate Committee Report Discovered in October last year.
blue cross blue shield of alabama Holds 92% of the state’s medical insurance marketunlike other organizations, does not use AI to determine pre-authorization applications. Massachusetts, florida and Californiahave.
The nonprofit group is consulting with insurers on a list of priorities for prior authorization reform, and a MASA spokesperson told ADN that the group is “optimistic to move forward without the need for legislation.”
BCBS spokeswoman Sophie Martin confirmed that the company is working with MASA to address BCBS’ concerns.
“We have been working with the association to share and clarify information with the goal of finding common ground wherever possible to ensure safe, appropriate and cost-effective care for the people of Alabama. ” she told ADN via email.
Williams said that because of its size, the BCBSA. “Really sets” the tone of the state.
“In many ways, they are doing great things for the state of Alabama and for patients and physicians, but the truth is that with all that power comes a lot of responsibility, and a lot of doctors are frustrated. I think a lot of what you can and can’t do is determined by things you can’t control,” she said.
“As doctors, we want to provide the highest quality treatment that modern medicine can offer. But what we face is a very intense level of oversight and the ability to function within. “It’s a very difficult system, making it almost impossible to provide good patient care,” said Harry McCarty, a physician at Alliance Cancer Care in Huntsville.
“Literally, there are few things in health care that create greater obstacles to patient care than the barriers put in place by health plans that are supposed to help serve patients.”
