The Growing Burden of Prior Authorization: How It Impacts Your Healthcare
Prior authorization – the practice of requiring your doctor to get approval from your insurance company before you can receive certain medical services, treatments, or medications - is becoming increasingly common. And, sadly, it’s creating significant hurdles for patients seeking timely and necessary care. Recent data reveals a concerning trend: a substantial portion of insured adults are facing difficulties navigating this process, leading to delays and even denials of coverage.
Just How Common is Prior Authorization?
The numbers are striking.Roughly half of insured adults (51%) have been required to obtain prior authorization for a healthcare service in the past two years. This isn’t a niche issue; it’s impacting a large segment of the population.
[Image of Datawrapper chart: Half of Insured Adults Have Been Required To Get Prior Authorization Before Receiving a Treatment or Service in the Past two Years]
the Difficulty of the Process
navigating prior authorization isn’t always straightforward. Nearly half of those who’ve needed prior approval describe the process as “somewhat difficult” (34%) or “very difficult” (13%). This complexity adds stress and time to an already challenging healthcare journey.[Image of Datawrapper chart: Half Say Process of Getting Prior approval for Health Care Was Difficult]
Delays and Denials: A Worrying Reality
The consequences of prior authorization extend beyond mere inconvenience. A significant number of individuals report experiencing delays or outright denials of care.
48% reported delays in receiving approved services. 43% experienced denials of coverage for services their doctor deemed necessary.
This translates to roughly 29% of all insured adults facing delays or denials in the past two years. Importantly,these issues appear to affect individuals across various insurance plans similarly.
[Image of Datawrapper chart: Three in Ten Had Their Insurance Company Deny or Delay Needed Care, Treatment, or Medication in the Past Two Years]
What’s Causing the Discrepancy in Reported Numbers?
While administrative data suggests lower rates of denials and delays, it’s crucial to consider the patient perspective. self-reported data from surveys, like the recent KFF Tracking Poll, often reveals higher numbers. This difference could be due to:
Misreporting: Individuals may not fully understand the reason for a delay or denial.
Initial Denials & Subsequent Approvals: A denial might be overturned after appeal, but the initial experience still impacts the patient.
Nonetheless, the data clearly indicates that many peopel feel their care is being delayed by the prior authorization process.
Which Services Require Prior Authorization Most Often?
Certain medical services are far more likely to require prior authorization than others. These include:
Surgery
Hospitalization
Imaging services (like MRIs and CT scans)
Specialty drugs
Specialty medical equipment
Care from a specialist
Specialized lab testing
Mental health services
If you require one of these specialized services, you’re significantly more likely (69% of insured adults) to encounter prior authorization requirements. And, within that group, over half (58%, or 36% of all insured adults needing specialized care) report delays or denials. Specifically:
30% experienced a delay in treatment.
27% experienced a denial of coverage.
What does This Mean for You?
The increasing prevalence of prior authorization is a growing concern. it’s adding administrative burdens to both patients and providers, potentially delaying access to necessary care, and creating needless stress.
What can you do?
Talk to your doctor: Discuss potential prior authorization requirements before scheduling a service.
Understand your insurance plan: Familiarize yourself with your plan’s prior authorization policies.
Be prepared to advocate for yourself: If you encounter a delay or denial, be prepared to appeal the decision and work with your doctor’s office to provide supporting documentation.Resources:
[KFF: Nearly 50 Million Prior Authorization Requests Were Sent to Medicare advantage Insurers in 2023](https://www.kff.org/medicare/issue-