A new Biden administration rule released Wednesday aims to streamline the prior authorization process used by insurers to approve medical procedures and treatments.
Prior authorization is a common tool used by insurers but much maligned by doctors and patients, who say it’s often used to deny doctor-recommended care.
Under the final rule from the Centers for Medicare and Medicaid Services, health insurers participating in Medicare Advantage, Medicaid or the ObamaCare exchanges will need to respond to expedited prior authorization requests within 72 hours, and standard requests within seven calendar days.
The rule requires all impacted payers to include a specific reason for denying a prior authorization request. They will also be required to publicly report prior authorization metrics.
There is nothing stopping it from being a retroactive investigation. Doctor prescribes it and then has to send evidence to the Insurance Company who can review it. If there’s a pattern of Bad behavior with one doctor they can press charges or something like that. But until then you’re holding up treatment on the suspicion of the possibility.
Thats what Medicare does. People around the hospital are afraid to fuck anything up because they will go back and take all of their money back.