Many medical practices spend an excessive amount of time on prior authorization (PA). According to the American Medical Association (AMA), this can delay treatment, leading to negative clinical outcomes. Hoping to decrease the burden of PA on both physicians and patients, the AMA has been working on a scaled-back, streamlined, automated PA process. However, this will take time.
In the meantime, allergists and immunologists must function within the current process, in which insurers usually reply to PA requests in 5 to 10 business days with approval, denial, a request for more information, or a recommendation with less expensive options. According to medical writer Naveed Saleh, MD, MS, the physician’s input is a significant factor in the insurer’s decision. PA approval benefits patients for many reasons. Insurer Cigna claims that in requiring an attempt at lower-cost options first, PA results in lower treatment costs. In addition,
Cigna suggests that PA lessens the use of unnecessary treatments or addictive medications
Strategies for Obtaining PA Approval
Therefore, it is in a physician’s best interest to employ certain strategies aimed at obtaining PA approval. For example, the AMA suggests that physicians review PA requirements prior to treating patients. This helps thwart denials and reduce prescription delays. It would also behoove allergists and immunologists to include any necessary PA-required documentation in a patient’s chart, minimizing the physician’s involvement and allowing other staff members to work on the PA. The AMA also suggests that physicians follow up with insurers to confirm both receipt
and timing of the PA request. Should an insurer deny a PA, physicians should take care to submit organized, succinct appeals.
Therefore, it is in a physician’s best interest to employ certain strategies aimed at obtaining PA approval. For example, the AMA suggests that physicians review PA requirements prior to treating patients. This helps thwart denials and reduce prescription delays. It would also behoove allergists and immunologists to include any necessary PA-required documentation in a patient’s chart, minimizing the physician’s involvement and allowing other staff members to work on the PA. The AMA also suggests that physicians follow up with insurers to confirm both receipt
and timing of the PA request. Should an insurer deny a PA, physicians should take care to submit organized, succinct appeals.
