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.
Well said. I have a nerve disorder which is controlled by medication, but it took a long time to get there and, for a while, he tried me on different opioids. I could easily have gotten seriously addicted (I did go through withdrawal symptoms after I stopped, but I had no problem stopping), but he was doing whatever he could to try and help me with my pain. He wasn’t trying to make money, he was trying to make me feel better. And it took about three years, but he finally did.