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No more "delay" in treatment because of prior authorization

I have a friend who has a chronic condition that forces her to deal with prior authorizations. When she switches from a boutique physician office to a major hospital, she starts to deal with the nightmare of prior authorization herself.

Between the insurance, hospital and specialty pharmacy, there is no coordinated effort to move forward with prior authorization approval. Patients have to wait days, weeks or even months for all 3 parties to go through the approval process. Sometimes, if there is incomplete paperwork or rejection, the approval process would be stuck. My friend, the super patient, would start calling all 3 parties and try to move the needle.

Do you know the American Medical Association has an ongoing petition to the congress to change the prior authorization?

More than 200 million Americans are covered by private health insurance. But data from state and federal regulators shows that insurers reject about 1 in 7 claims for treatment.

The criteria for prior authorization can vary between different insurances. The process and policy are opaque. Physicians very often lack the information during prescribing and know if the treatment requires prior authorization. That causes patients' access to medication or tests delayed or denied.

94% physicians say prior authorization often or always causes care delay.

One way to solve this problem is through technology. AI can work as the super agent here, sucking in all the in-and-out of the prior authorization policies and spit out detailed guidelines to physicians when a patient steps in the hospital on day one. Patient encounter notes can trigger the prior authorization process and receive approval on time, and in turn provide much needed care to patients.


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