Dr. Marvin Malek: We need to act to rein in ‘prior authorization’
VTDigger
The Legislature should pass H.766, the bill now being considered by the Vermont Senate that takes some first steps reining in the insurance company practice of “prior authorization.”
Here’s how prior authorization works: Let’s say that you’ve been dutifully paying your health insurance premiums each month and have had no medical issues. Finally, you develop a problem, have an office visit with your doctor, and your doctor orders various tests and treatments. You expect your insurer to simply cover the treatment plan. But the insurer has another option.
Your insurer can claim that it needs evidence to determine whether the doctor’s plan is actually necessary. This is known as “prior authorization.” The insurance company can require your doctor’s practice to complete insurers’ forms, fax portions of patients’ medical records (so much for confidentiality…) and schedule discussions between provider staff members at all levels — administrative staff, nurses and physicians — and representatives from the insurance company. Often, multiple forms are required, one after the next. Sometimes days go by between the practitioner ordering the test and getting a final ruling from the insurance company.