Medical Economics February 10, 2023
KFF breaks down approvals, denials, and appeals in 2021 requests sent to insurance companies.
Physicians, patients, lawmakers, and government policy makers all have voiced their frustrations about prior authorizations for medical treatment.
The practice is “intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a service or other benefit will be covered by a patient’s insurance,” said a new KFF report that analyzed prior authorization requests to insurance companies in Medicare Advantage plans.
Prior authorization contains spending and prevents patients from receiving unnecessary or low-value services, but there are concerns the practice creates barriers and delays to care, while being complex for patients, physicians, and other providers,...
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