Prior Authorization Less Likely to be Granted for Mental Health

HealthLeaders Media April 8, 2022
Jay Asser

According to a study by the U.S. Government Accountability Office (GAO), patients face greater challenges with receiving approval for mental health services than medical services.

The demand for mental healthcare is on the rise, but even those with coverage are experiencing difficulties accessing services, a new study by GAO found.

One of those hurdles is prior authorization, which is less likely to be granted for mental health hospital stays compared with medical and surgical hospital stays, according to the study.

For the report, GAO interviewed federal officials and representatives from 29 stakeholder organizations representing consumers, health plans, providers, insurance regulators, and mental health and Medicaid agencies.

Sixteen of the 29 stakeholder organizations pointed to non-quantitative treatment limitations (NQTLs) used by...

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