Insurance Holdups & Hassles

The US healthcare system has a lot of problems, but here’s a big one: health insurance companies demand pre-authorization for many vital treatments and services. They say it is to keep costs down, but in reality, it makes it even more challenging for patients to get the healthcare they need…when they need it. 

Mandatory pre-authorization rules delay treatment, create more paperwork for doctors’ offices, and interfere with doctors and patients making medical decisions together. 

The solution? More transparency and accountability regarding plan coverage and fewer healthcare services requiring a pre-authorization. This way, patients and doctors can make timely individualized healthcare choices without jumping through unnecessary hoops. Having medical issues, whether life threatening or routine, is stressful enough as it is without waiting for insurance providers to green light your treatment. 

Effects on Patient Care

Anyone who has ever used the healthcare system before knows that we’re talking about a space where life literally hangs in the balance. Time is not on everyone’s side. Pre-authorization refusals can cause risky holdups in receiving necessary treatment, dragging on for days or even weeks before consumers get a response from their health insurance provider. In 2023, 22 percent of adults insured under Medicaid experienced pre-authorization problems, along with 11 percent of those insured through Medicare and 15 percent using employer-sponsored coverage. 

You’ve probably heard someone in your life say, “Thankfully, we caught it in time,” when sharing news of an illness. In too many cases, delays result in a patient’s condition getting worse, so much that they need additional pre-authorizations for health care services as a result of the first pre-authorization. Research shows that of the adults who had more than 10 doctor visits in 2023, 31 percent experienced pre-authorization challenges. 

Comparatively, adults who visited the doctor 3 to 10 times had pre-authorization problems at a rate of 20 percent. 

Those who visited just 2 times or less had pre-authorization problems at a rate of 10 percent. 

This demonstrates that those who need more healthcare services are the ones most likely to be denied pre-authorizations, increasing delays and overall harm to their health. 

Patients with serious illnesses are at a major disadvantage with health insurance companies. 

Let’s say you have a rare chronic lung disease that requires special medication and treatment. Your doctor finds a groundbreaking treatment, but the insurance company wants to approve it first. If the insurer labels the treatment ‘experimental’, then you will likely be denied pre-authorization and will find yourself stuck in red-tape limbo while your health continues to deteriorate — even if the doctor recommends action. 

Patients deserve a choice in their healthcare treatments, without health insurance companies getting in the way of decisions made between patients and their doctors. 

Cut Down on Pre-Authorization Rules & Increase Transparency

An easy reform to increase patient choice and enhance care is to reduce the number of medical services that require pre-authorization. Rather than depending on insurance companies to approve treatments beforehand, we would empower doctors to make the best choices with their patients, and reduce outside meddling. 

Additionally, if insurance policies were more transparent, patients could easily compare plans based on which treatments need pre-authorization. This would spark competition among insurers and push them to simplify, or perhaps even get rid of pre-authorization approvals altogether in a bid to attract consumers. 

Pre-authorization denials reveal a broken approach to healthcare that prioritizes cost-cutting over patient health. By reducing services that require pre-authorization and increasing transparency for coverage upfront, we can rip through the needless red tape holding back patients with better healthcare delivery. 

These changes wouldn’t solve all of the pitfalls of the American healthcare insurance system, but it would certainly get us closer to a system that prioritizes patient care above all else.