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How to choose health plan when it comes to prior authorization

Prior authorization is a tool for insurance companies to control cost. When the treatment or medication is too expensive, insurance uses prior authorization as a gatekeeper. I totally get the idea of controlling cost, but it is the 2nd order effect that has done a lot of damage to patients. Each prior authorization rejection represents a struggling patient who won't get the care they deserve.

More than nine in 10 physicians (93%) reported care delays while waiting for insurers to authorize necessary care, and 82% said prior authorization can lead to treatment abandonment because of prior authorization struggles with their insurance company.

During spring, it is time for employers to shop around for insurance for their employees. When employees suffer from delayed treatment due to prior authorization, it impacts productivity and performance. Before making decision on next health plan for their employees, employer should ask potential insurance companies these questions:

1. What percentage of claims are subject to prior authorization in the last 5 years?

2. What is the denial rate of all the prior authorization?

3. Which speciality has the highest denial rate?

4. What is the average review time to get an approval?


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