Affordable Access

Access to the full text

Preauthorization

Authors
  • Brown, Gary C.1, 2, 3, 4
  • Brown, Melissa M.1, 2, 3, 4
  • 1 Center for Value-Based Medicine®, Hilton Head, SC, 29928, USA , Hilton Head (United States)
  • 2 Eye Research Foundation, Philadelphia, PA, USA , Philadelphia (United States)
  • 3 Jefferson Medical University, Wills Eye Hospital, Philadelphia, PA, USA , Philadelphia (United States)
  • 4 Emory University School of Medicine, Department of Ophthalmology, Atlanta, GA, USA , Atlanta (United States)
Type
Published Article
Journal
Current Ophthalmology Reports
Publisher
Springer US
Publication Date
Aug 08, 2018
Volume
6
Issue
3
Pages
181–190
Identifiers
DOI: 10.1007/s40135-018-0182-3
Source
Springer Nature
Keywords
License
Yellow

Abstract

Purpose of ReviewThe goal herein is to discuss preauthorization for U.S. diagnostic and therapeutic interventions and ascertain the benefits and adverse events associated with it. Preauthorization is the process of requiring a physician to obtain permission from a healthcare insurer to perform a diagnostic or therapeutic procedure.Recent FindingsPreauthorization is widespread across health insurers, with the average physician performing 37 per week. The process occupies 20 h/week for the average physician and/or staff, for which there is no compensation for excess time spent. The mean cost of interacting with insurers has been estimated to be $83,000 per physician per year. Approximately 79% of preauthorizations are eventually approved, with 72% approved on initial submission and 7% on subsequent submissions. In one poll, 94% of physicians thought preauthorizations were never or almost never appropriate. The AMA has suggested simplification, standardization of forms among insurers, insurer response within 2 days, fair compensation for the process, and transparency, accessibility and consistent application of requirements. Other methods of healthcare cost saving may be superior to preauthorization.SummaryPreauthorizations place considerable financial and time burdens on physicians and their practices. An overwhelming percent of physicians believe they are unnecessary, and even insurers admit that they are utilized in instances to keep down the costs of healthcare.

Report this publication

Statistics

Seen <100 times