Monday, July 19, 2021 | 2 a.m.
View more of the Sun's opinion section
The health insurance industry is riddled with issues that stand in the way of patients receiving the care they rightly need. And the constant chatter we hear about solutions to these problems doesn’t seem to help.
In my practice, one problem stands out: It’s prior authorization, which requires physicians to secure approval from insurers for needed procedures or medications prior to patients receiving the prescribed procedures and medications.
The costs of prior authorization are high — not just in dollars, but in patient health.
The average physician completes 31 prior authorization requests each week, which takes roughly two days of physician and staff time that could be better spent on patient care. Patient care should be the priority, and money spent on staff should benefit the patient and their care; not spent appeasing insurance companies concerned with their bottom lines while ignoring those of providers and patients.
Forcing patients to delay important tests and treatments, or making them pay for expensive procedures and medications out-of-pocket when they have health insurance, is outrageous.
Health insurance companies argue that prior authorization requirements are necessary to contain health care costs. However, denying a prescription, test or treatment might save money in the short term, but over time, the lack of timely treatment could lead to hospitalizations and more costly treatments that negate any initial cost savings.
It’s not the monetary costs that are most detrimental, though. It is the risk to patients’ health. The process of seeking prior authorization often results in significant delays in care and dangerous denials for tests, treatments and medications that doctors are recommending. Forcing patients to wait days, weeks and even months for the procedures and medicines they need can have life-threatening consequences. An American Medical Association (AMA) survey of 1,000 physicians found that 9 in 10 reported prior authorizations delayed access to necessary care and more than 25% said the delays had led to a serious adverse event.
I witness the perils of prior authorization daily at my business, MHS Behavioral Services. I opened my business five years ago after witnessing patients, especially those with long histories of trauma, not receiving the services they needed. We feel fortunate to assist these individuals.
However, as a provider, it is beyond frustrating to have insurance companies dictate care plans versus allowing us professionals to actually treat patients.
One such family’s story still haunts me. We first began treating the father for schizophrenia. Significant progress was being made, but still he had further to go. However, to continue his care, prior authorization was required. The insurance company denied his continued treatment. Appeals were also denied. Around this same time, the state had removed his preteen daughter and teenage son from their mother’s home and placed them with him.
Three weeks in, and without continued care, he was completely overwhelmed and relapsed. His children then had to be taken and placed in foster care. Continued care for him could’ve prevented such a tragedy — and kept a family together.
Although this example is a more extreme case, any delay or denial of care can have serious and, even in some cases, deadly repercussions.
Someone sitting in an insurance office cubicle should not be making treatment decisions for patients — doctors and providers should be.
Both professionally and personally, I make it my mission to “be the change.” In this case, however, some help from our state and federal legislators ensuring Americans have access to quality, affordable health care by enacting common-sense reforms would be welcomed.
Dinisha Mingo is the CEO of Mingo Health Solutions.
