Insurers eventually approve most denials, though payer-mandated changes may be compromising care

Radiology Business June 13, 2024
Marty Stempniak

Insurers eventually approve most denials, but payer-mandated changes to the care process could be compromising patient care, experts detailed Wednesday in JAMA Network Open.

Physicians have faced an “increasingly challenging” path to providing care due to prior authorization requirements. Payers often impose these checks and balances to determine whether care is “medically necessary,” sometimes delaying services by “days to even months.”

Memorial Sloan Kettering researchers sought to understand how this plays out in radiation oncology, analyzing a sample of 206 denials from their institution. Of those, 98% eventually led to the delivery of radiation therapy, with average delays of nearly 8 days (and a range from 1 to 49).

“Prior authorization can generate both significant time and financial burdens on...

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