Deadly Denials

Designed to prevent doctors from deploying expensive, ineffectual procedures, prior authorization — sometimes called pre-authorization or pre-certification — has become a confusing maze used by health insurance companies that denies or delays care, burdens physicians with paperwork, and perpetuates racial disparities. Proposed federal rules may not be enough to solve the problems.

States Get in on the Prior Authorization Crackdown

KFF Health News Original

Last month, my colleague Lauren Sausser told you about the Biden administration’s crackdown on insurance plans’ prior authorization policies, with new rules for certain health plans participating in federal programs such as Medicare Advantage or the Affordable Care Act marketplace. States are getting in on the action, too. Prior authorization, sometimes called pre-certification, requires patients […]

States Target Health Insurers’ ‘Prior Authorization’ Red Tape

KFF Health News Original

Doctors, patients, and hospitals have railed for years about the prior authorization processes that health insurers use to decide whether they’ll pay for patients’ drugs or medical procedures. The Biden administration announced a crackdown in January, but some state lawmakers are looking to go further.

Biden Cracks Down on Prior Authorization — But There Are Limits

KFF Health News Original

More than a year after it was initially proposed, the Biden administration announced a final rule yesterday that will change how insurers in federal programs such as Medicare Advantage use prior authorization — a long-standing system that prevents many patients from accessing doctor-recommended care. “When a doctor says a patient needs a procedure, it is […]

Hospitals and Doctors Are Fed up With Medicare Advantage

KFF Health News Original

Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans — they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF’s count. But among doctors and hospitals, it’s a different story. Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans […]