CMS Imaging's Response to COVID-19
RSS Feed

Prior Authorizations

The Nightmare Continues...

21st Century Consumerism

A few months ago, I wrote about "21st Century Consumerism and the Nightmare of Prior Authorizations" . Well, it seems that I am not the only one that sees them as such, this week the American Medical Association (AMA) released a video entitled "Prior Authorization is a Nightmare."

Throughout the video, physicians of varied specialties speak about how prior authorizations has affected their practices and the impact they have on their patients. Two eye-opening statistics delivered in this video are that as of the "December 2017 AMA Prior Authorization Physician Survey" *:

      1. The average total prior authorizations per week per physician is 29.1. *
      2. The average hours spent weekly by the physician or staff to complete the prior authorization workload is 14.6. *

These statistics translate into almost two-business days per week spent communicating with insurance companies. Because of this, 34% of the physicians surveyed have staff who exclusively work on prior authorizations. Moreover, 79% of the physicians who responded to the survey mention that in addition to the prior authorizations necessary to see and treat their patients, "sometimes, often, or always *" do they or their staff have to repeat the prior authorizations for prescription medication.

Similarly, the "American Medical Association / Dartmouth study on patient time vs. EHR and clerical tasks **" reveals that prior authorizations are the second largest source of physician dissatisfaction.

"I’d say prior authorizations kill us. Ugh, the amount of time we spend on prior authorizations." **

- Anonymous Physician of Internal Medicine

"One of the most frustrating things … insurance companies will tell us ‘we don’t cover that medication’ but then (they) never give us alternatives. So, we have to guess on prescriptions and turns out they don’t cover that one either. Then next time we pick a different one and again they don’t cover it. It creates a ton of work for the providers, nurses, and then it comes back to us, and then the chart needs to be pulled again by the receptionists. It’s just many people having to look up the same information over and over again, which can be time-wasting." **

- Anonymous Physician of Internal Medicine

The same AMA/Dartmouth study exposes the consequences of the nightmare that is prior authorizations.

"The amount (of time) on paperwork and minutia (takes away from) taking care of patients—the actual patient care." **

- Anonymous Cardiology Physician

"(The insurance company) treats the patients very poorly … it’ll be two years soon and they won’t authorize the surgery and the guy is completely crippled, he can’t work, he lost his home … they wouldn’t even allow him to see the people I referred him to. So he wasn’t getting any care, any steroid shots, any physical therapy … he complained to someone that he was getting really sick of this, and they said ‘oh, he’s depressed now, he needs to see the psychiatrist, we are going to halt all treatment until he sees the psychiatrist.’ The only psychiatrist they would allow took six months to schedule. So no more treatment ‘till he sees the psychiatrist." **

- Anonymous Physician of Internal Medicine

From a patient's perspective, prior authorizations sometimes prevent us from receiving the recommended care we need when we need it. In the prior authorization process, our physician knows the best treatment for us; however, the insurance companies must approve or deny the treatment that our physicians recommend. As a result, plan administrators, not physicians are often the ones making the final decisions concerning our health.

Prior Authorizations are a nightmare. I rest my case.

The AMA is advocating for their members, but more importantly, they are advocating for their patients. They are petitioning the US Congress to make things better. They want to work with insurance companies to provide better care for their patients. They are seeking to streamline and add more transparency to the authorization process. If you'd like to sign their petition, visit their webpage at

For the physicians, in the interim, there are solutions to mitigate the negative impact caused by prior authorizations. There exists software using artificial intelligence and machine learning to reduce the workload, time, and cost of prior authorizations.