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Securing approval for reimbursement of care in a medical care system affected by overuse and ineffective care seems logical and arguably protective of patients’ interests. However, the prior authorization process has now become a significant burden on clinicians, patients, and health care organizations. Even though some organizations are actively advocating to reduce the financial implications and time requirements caused by this process, the full effects and consequences of prior authorization on patients and their families (particularly reversals of authorization after the fact) remain enormous. Along with whatever protections against unnecessary care that it offers, prior authorization has created a minefield of financial risks for patients and their families.
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Gaines ME, Auleta AD, Berwick DM. Changing the Game of Prior Authorization: The Patient Perspective. JAMA. Published online February 03, 2020. doi:10.1001/jama.2020.0070
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