How Insurance Works

Sen. Holmes: Insurance prior Authorization requirements are interrupting and delaying care


The purpose of these bills is to make sure that the prior authorization requirements that are utilized by
health care insurance entities works as intended. Unfortunately, after talking
with physicians and patients, it’s clear that these requirements are not being
used for that purpose. Prior authorization requirements are applied
excessively, on important medical treatments and tests, even the most
common medically necessary services. This is an issue that impacts all patients,
whether it’s a child being treated for asthma, a pregnant mom in need of an
ultrasound, a senior in need of stress tests or a patient with a new cancer
diagnosis. Medical care is being interrupted and delayed and these delays
can cause the condition to worsen and, of course, the anxiety and the physical pain
that the patients are going through is intolerable. So, we need to change this.
Health care professionals need to know what’s being subjected to prior
authorization, and patients need to know that their medical needs will receive
the necessary care, most importantly, in a timely manner. And, health insurer
entities need to be held accountable when they don’t deliver the promises
they made.


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