Health insurer abuse of patients must end
More than nine in 10 physicians reported care delays while waiting for health insurers to authorize necessary care, and more than four in five physicians said patients abandon treatment due to authorization struggles with health insurers. Exhausted by the fight, they simply give up. That’s according to a new survey conducted by the American Medical Association.
Those are just statistics. Here’s what they mean for real people in North Carolina.
A Winston-Salem woman was recently diagnosed with a cataract. Cataracts are a common condition. They cause vision to blur, and the only treatment is surgery. After scheduling her surgery, the patient took time off work, arranged for transportation and support at home when she returned.
When the day arrived, as she waited to be prepped for surgery, she learned that all the effort was wasted. Her insurer, Aetna, had denied coverage.
This isn’t an isolated case. This is happening to an increasing number of people, from Asheville to Zebulon, and across the country, because insurance companies are abusing a practice called prior authorization.
Prior authorization is the process that requires physicians to get advance approval from health plans before they will agree to cover a medical service or a medication. Originally intended as a cost containment measure for expensive new drugs and tests, it’s now used to delay and deny common drugs and procedures prescribed by physicians.
Aetna – the nation’s third-largest insurer – recently started an especially abusive application of prior authorization. It requires pre-approval for all cataract surgeries, from children to adults, regardless of the patient’s health status.
Since it went into effect last summer, Aetna has needlessly delayed thousands of vision-saving surgeries. This is extremely concerning because cataracts increase the risk of an individual falling, getting into a motor vehicle accident, and developing dementia and Alzheimer’s disease. With Aetna joining the North Carolina marketplace for the first time in 2022, and with Medicare Advantage enrollment growing throughout the country, this abuse must be confronted now.
The situation is more dire than just care delays. That survey from the American Medical Association also found that one-in-three doctors report that prior authorization has led to a serious adverse reaction to a patient in their care, while a shocking 8 percent said it caused a patient to suffer a permanent disability, permanent bodily damage, birth defect or death.
Congress has an opportunity to protect North Carolinians from this dangerous trend by passing legislation that would create needed guardrails around prior authorization. The Improving Seniors’ Timely Access to Care Act is bipartisan legislation introduced last year that would require Medicare Advantage plans to streamline prior authorization so that care is not needlessly disrupted. It would also create much-needed protections and hold plans accountable for abusing the prior authorization process.
In a sign of how popular the bill is on both sides of the aisle, more than 250 representatives in the U.S. House – including nine from North Carolina – have co-sponsored the bill. U.S. Sen. Thom Tillis (R-N.C.) has co-sponsored the legislation in the Senate.
We’re grateful for these champions for patient access to health care. With more patients at risk of being caught up by insurance companies’ prior authorization overreach, we urge all members of Congress to support the bill and quickly pass it into law.
– Drs. Susan Burden and Bob Park