Free Republic

In a press conference on Monday, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced a landmark agreement with the nation’s largest health insurers to tackle the number one healthcare problem plaguing hundreds of millions of Americans: prior authorization. Prior authorization is the requirement for doctors and patients to get advance approval from insurance companies BEFORE certain treatments, tests, or procedures are covered. It was meant to control costs, but for 85% of Americans, it’s become a serious barrier to care. “Doctors like myself are continually struggling with this issue,” Dr. Oz said, explaining how the...

For patients with chronic conditions, including inflammatory bowel disease (IBD), newer drugs like biologics can be effective—but also expensive. As a result, many insurance companies have limited access to these medications—and physicians are forced to jump through hoops. According to a recent story, insurance companies sometimes have their physicians reject claims without even reading them. To address these challenges, Athos Bousvaros, MD, MPH is calling for change—and providing specialists with the tools they need to navigate an increasingly difficult approval process. In a recent paper, Bousvaros and his colleague Stacy Kahn, MD detail how complicated the approval and denial process...

…Prior authorization is a common cost-cutting tool used by health insurers that requires patients and doctors to secure approval before moving forward with many tests, procedures, and prescription medications. Insurers say the process helps them control costs by preventing medically unnecessary care… That's why desperate patients like Nix—and even some physicians—say they have turned to publicly shaming insurance companies on social media to get tests, drugs, and treatments approved… But some patient advocates and health policy experts question whether insurers are using prior authorization as "a possible loophole" to this prohibition, as a way of denying care to patients with...