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Prior Auth Insurance Delays Hurt Patients; Legislation Aims to Improve Process


Patients Hurt By 
Prior Auth Delays

Click on the names below to
learn more about their stories.
 
Joe Stanziano,
Montgomery County (Pa.)

Insurance delays prevented him from
tapering off post-surgery pain meds.


Kristen O'Toole, Pittsburgh
Delayed MRI allowed her undiagnosed Multiple Sclerosis to progress.


Jeff Duncan, Pittsburgh
Waited eight months to confirm and treat severe sleep disorder.

 

 

The Problem

Prior authorization delays from insurance companies are hurting patients who need care.

The Solution

The Pennsylvania Medical Society and 50+ organizations support state legislation that aims to decrease patient wait times by streamlining the prior auth process and increasing transparency from insurance companies.

Current Status

House Bill 1293 was introduced in May 2017 by Rep. Marguerite Quinn (R-Bucks) and currently resides in the House Insurance Committee.

How You Can Help

We cannot move this bill without strong grassroots efforts from physicians, medical office staff, and, most importantly, patients who have been impacted from prior auth delays.

  1. If your House member is on the House Insurance Committee, contact them today!
  2. If your health has been impacted by a prior auth delay, share your story.

 

House Bill 1293 Highlights

  • Requires insurers to post on its website a current list of services and supplies in need of prior authorization and the written clinical criteria
  • Restrictions an insurer places on prior authorization services must be based on the medical necessity or appropriateness of those services and on written clinical criteria
  • Appeals must be reviewed by a physician who is board certified in the same specialty and in active clinical practice
  • Requests for an urgent decision must be answered within one business day; non-urgent PAs must be answered in two business days.
  • Any change to a prior authorization requirement or a restriction must be made at least 60 days before the requirement or restriction is implemented
  • Health insurers may not retroactively deny coverage for emergency or non-emergency care that had been preauthorized.

House Insurance Committee Members

If your state representative is a member of this committee (listed below), we strongly urge you to contact them through PAMED's Voter Voice:

Find your House member

  • Rep. Tina Pickett, Chair (R-110th, Bradford, Sullivan, and, Susquehanna counties)
  • Rep. Anthony DeLuca, Democratic Chair (D-32nd, ​Allegheny County)

Majority

  • Rep. Steven Mentzer, (R-97th, Lancaster County )
  • Rep. Lynda Schlegel Culver (R-108th, ​Northumberland and Snyder counties)
  • Rep. Gary Day (R-187th, Berks and Lehigh counties)
  • Rep. Harold English (R-30th, Allegheny County)
  • Rep. Eli Evankovich (R-54th, Allegheny and Westmoreland counties)
  • Rep. Robert Godshall (R-53th, Montgomery County)
  • Rep. Rich Irvin (R-81st, Centre, Huntingdon, Mifflin counties)
  • Rep. Warren Kampf (R-157th, Chester County)
  • Rep. Ryan Mackenzie (R-134th, Berks and Lehigh counties)
  • Rep. Tedd Nesbit (R-8th, Butler and Mercer counties)
  • Rep. Marguerite Quinn (R-143rd, Bucks County)
  • Rep. Brad Roae (R-6th, Crawford and Erie counties)
  • Rep. Justin Simmons (R-131st, Lehigh, Montgomery, and Northampton)
  • Rep. Curtis Sonney (R-4th, Erie County)
  • Rep. Mike Tobash (R-125th, Dauphin and Schuylkill)

Minority

  • Rep. Ryan Bizzarro (D-3rd, Erie County)
  • Rep. Dom Costa (D-21st, Allegheny County)
  • Rep. Margo Davidson (D-164th, Delaware County)
  • Rep. Tina Davis (D-141st, Bucks County)
  • Rep. Jason Dawkins (D-179th, Philadelphia County)
  • Rep. Michael Driscoll (D-173rd, Philadelphia County)
  • Rep. Marty Flynn (D-113th, Lackawanna County)
  • Rep. Ed Gainey (D-24th, Allegheny County)
  • Rep. Robert Matzie (D-16th, Allegheny and Beaver counties)
  • Rep. Perry Warren (D-31st, Bucks County)

      of medical offices say they have experienced an increase in the number of prior authorizations over the past year.

Prior Auths On The Rise

Physicians have seen a dramatic rise in prior authorizations over the past few years for a variety of treatments and medications:

  • 86 percent of respondents to a Medical Group Management Association survey (May 2017) said that they experienced an increase in the number of prior authorizations over the past year.
  • Medical practices average 37 prior authorizations per week, per physician (taking up an average of 16 hours per physician), according to a survey from the American Medical Association.

Patient and Physician Advocacy Organizations Supporting HB 1293:

  • Pennsylvania Medical Society
  • Allegheny County Medical Society
  • Arthritis Foundation
  • Berks County Medical Society
  • Bradford County Medical Society
  • Bucks County Medical Society
  • Cambria County Medical Society
  • Carbon County Medical Society
  • Centre County Medical Society
  • Chester County Medical Society
  • Clarion County Medical Society
  • Clearfield County Medical Society
  • Dauphin County Medical Society
  • Delaware County Medical Society
  • Eastern Pennsylvania Chapter of National Hemophilia Foundation
  • Erie County Medical Society
  • Fayette County Medical Society
  • Global Healthy Living Foundation
  • Lackawanna County Medical Society
  • Lancaster City and County Medical Society
  • Lawrence County Medical Society
  • Lebanon County Medical Society
  • Lehigh County Medical Society
  • Luzerne County Medical Society
  • Lycoming County Medical Society
  • Montgomery County Medical Society
  • National Eczema Association
  • National Multiple Sclerosis Society
  • National Psoriasis Foundation
  • National Patient Advocate Foundation
  • Northampton County Medical Society
  • Pennsylvania Ambulatory Surgery Association
  • Pennsylvania Academy of Family Physicians
  • Pennsylvania Academy of Dermatology
  • Pennsylvania Academy of Ophthalmology
  • Pennsylvania Academy of Otolaryngology — Head and Neck Surgery
  • Pennsylvania Allergy & Asthma Association
  • Pennsylvania American Congress of Obstetrics and Gynecologists
  • Pennsylvania Chapter of the American College of Cardiology
  • Pennsylvania Chapter, American College of Physicians
  • Pennsylvania Neurosurgical Society
  • Pennsylvania Orthopeadic Society
  • Pennsylvania Psychiatric Society
  • Pennsylvania Society of Anesthesiologists
  • Pennsylvania Society of Gastroenterology
  • Pennsylvania Society of Oncology and Hematology
  • Philadelphia County Medical Society
  • Potter County Medical Society
  • Robert H. Ivy Pennsylvania Plastic Surgery Society
  • Schuylkill County Medical Society
  • Union County Medical Society
  • Warren County Medical Society
  • Washington County Medical Society
  • York County Medical Society

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