February 17, 2022
A new study, released February 10 by the AMA, finds that prior authorization (PA) requirements on evidence-based care can have severe consequences that interfere with a healthy, productive workforce.
“Health insurance companies entice employers with claims that prior authorization requirements keep healthcare costs in check, but often these promises obscure the full consequences on an employer’s bottom line or employees’ well-being,” said AMA President Gerald Harmon, MD. “Benefit plans with excessive authorization controls create serious problems for employers when delayed, denied or abandoned care harms the health of employees and results in missed workdays, lost productivity and other costs.”
According to the AMA survey, more than half (51%) of physicians who care for patients in the workforce reported that PA had interfered with a physician’s job responsibilities. In fact, more than one-third (34%) of physicians reported that PA led to a serious adverse event, such as hospitalization, disability, or even death, for a patient in their care. Also, more than nine in 10 physicians (93%) reported care delays while waiting for health insurers to authorize necessary care, and more than four in five physicians (82%) said patients abandon treatment due to prior authorization struggles with health insurers.
The findings of the AMA survey illustrate a critical need to streamline PA requirements to minimize delays or disruptions in care delivery. Health plans agreed to make series of improvements to the PA process several years ago, but despite harmful consequences of delayed or disrupted care, most health plans are not making meaningful progress on reforms.
To help employers choose the right health plan to provide coverage for their workforce, the AMA offers the following recommendations:
Ask health insurance plans questions during the next benefit contracting season. The AMA offers employers a list of questions to ask health plans about how their PA requirements may impact employees.
Solicit feedback from employees about their experience with PA. The AMA encourages employers to use a benefit satisfaction survey, anonymous HR complaint line, or open engagement with HR representatives.
Take action by visiting FixPriorAuth.org to learn more. Employers can submit stories and sign the AMA’s reform petition.
May 29, 2025
As the Legislature works to complete its work on the state’s two-year budget, another deadline is looming. Legislators are required to pass a balanced budget before the end of the fiscal year—June 30, 2025. If they don’t meet that deadline, the state will begin a partial shutdown.
May 29, 2025
Registration has opened for the Empowering Physicians: A Night of Reflection and Engagement event, featuring best-selling author Elisabeth Rosenthal, MD.
May 29, 2025
The AMA is encouraging physicians to contact their U.S. senators and urge them to revise the reconciliation bill passed recently by the U.S. House of Representatives. While the bill includes language that would stabilize Medicare physician payments, it also threatens to cripple Medicaid and CHIP.