Society Supports Legislation Aimed at Protecting Patients from Delays in Care

Last week the Society joined other national and state medical societies in supporting the Improving Seniors’ Timely Access to Care Act of 2019 (H.R. 3107), which was recently introduced by Reps. Suzan DelBene (D-WA); Mike Kelly (R-PA); Roger Marshall, MD (R-KS); and Ami Bera, MD (D-CA). The bill would improve delivery of care by streamlining and standardizing prior authorization in Medicare Advantage (MA), while also providing much needed oversight and transparency of health insurance for America’s seniors.

Prior authorization is a tool used by insurers to reduce spending through improper payments and unnecessary care by requiring physicians and other health care professionals to get preapproval for medical services. However, it’s not without fault. Each plan has a unique way of handling prior authorization, often requiring the faxing of a patient’s medical information or phone calls by clinicians, which takes precious time away from patient care and can potentially lead to a delay of needed medical intervention.

This bipartisan legislation would improve the prior authorization process in MAplans through common-sense transparency, electronic adoption, and an analysis of the items and services subject to prior authorization. Of all the much-needed updates to prior authorization, none is more critical than ensuring that health plans make prior authorization available in “real time” for routinely approved services so that physicians and their staff have more time to spend on patient care, rather than paperwork. In addition, the bill includes an important surgical exception that allows the surgeon to rely on the initial authorization if he/she needs to perform additional services while the patient is in surgery. 

Click here  to read letter of support.