A new Biden administration rule released Wednesday aims to streamline the prior authorization process used by insurers to approve medical procedures and treatments.
Prior authorization is a common tool used by insurers but much maligned by doctors and patients, who say it’s often used to deny doctor-recommended care.
Under the final rule from the Centers for Medicare and Medicaid Services, health insurers participating in Medicare Advantage, Medicaid or the ObamaCare exchanges will need to respond to expedited prior authorization requests within 72 hours, and standard requests within seven calendar days.
The rule requires all impacted payers to include a specific reason for denying a prior authorization request. They will also be required to publicly report prior authorization metrics.
It isn’t about what’s actually medically necessary. Insurance companies will use any excuse to pull bs. It greatly matters how a court would view it. People are stupid and could buy the insurance companies arguments that it wasn’t made clear that it was medically necessary. Its also important that scheduled procedures are generally termed “elective” even if they are something like a necessary heart procedure. That terminology could be confusing to people who are not medically literate. Making it harder to make a case against them should something happen. They know this and fuck around. CPT codes only tell them what the condition is. There are some conditions that are not life threatening but still God awful to deal with having. You better believe they try to make people try treatments their doctor already knows won’t work and otherwise try to find excuses for why its not medically necessary.
It doesn’t matter that you don’t think such language should be necessary. This is the real world. Not some fantasy land in your head. Our Supreme Court is clearly incapable of reading the constitution. Why on earth would you think anybody else in this country would be able to read? Especially when they already have policies to intentionally hassle people because it saves them money. Its obvious you’ve never interacted extensively with the American Healthcare system or have only used it with Medicare. Preauths are one of the worst things I have to deal with at my job.
