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

Last Updated: Dec 14, 2017

When you are sick or in pain, time is of the essence. And yet many Pennsylvanians aren't receiving the timely care they need because of an insurance process called prior authorization.
 
Evidence is emerging that this inefficient system hurts patients and, in some cases, puts their lives at risk.
 

Tell your state Representative to support House Bill 1293, which aims to improve the prior auth process and increase transparency from insurers.

Take Action 


Patients Hurt By Prior Auth Delays
Click on the names below to 
learn more about their stories.

Prior-Auth-Joe-Stanziano

Joe Stanziano, Montgomery County (Pa.)

Insurance delays prevented him from
tapering off post-surgery pain meds.
 
Prior-Auth-Kristen-OToole

Kristen O'Toole, Pittsburgh

Delayed MRI allowed her undiagnosed Multiple Sclerosis to progress.
 
Prior-Auth-Jeff-Duncan

Jeff Duncan, Pittsburgh

Waited eight months to confirm and treat severe sleep disorder.

Prior-Auth-Souders

Zachary Souders, Middletown, Pa.

As reported in Harrisburg Patriot-News, waited months to get medication to address his juvenile idiopathic arthritis.

Prior-Auth-Pam-Moyer

Pam Moyer, Scranton, Pa.

What started as a toothache turned into two years of delays and pain.
 

Click here to share your story




How You Can Help

HB 1293 was introduced in May 2017 by Rep. Marguerite Quinn (R-Bucks), and is supported by a coalition of more than 50 patient and medical advocacy groups, including the Pennsylvania Medical Society.

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. Contact your House member today!
  2. Make an official complaint to the Pennsylvania Department of Insurance. Use to this link and follow the instructions.
  3. 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 pre-authorized. 

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:
 
 
  • Rep. Tina Pickett, Chair (R-110th, Bradford, Sullivan, and, Susquehanna counties)
  • Rep. Anthony DeLuca, Democratic Chair (D-32nd, Allegheny County)
Majority
 
  • Rep. Steven Mentzer, Secretary (R-97th )
  • Rep. Lynda Schlegel Culver (R-108th)
  • Rep. Gary Day (R-187th)
  • Rep. Harold English (R-30th)
  • Rep. Eli Evankovich (R-54th)
  • Rep. Robert Godshall (R-54th)
  • Rep. Rich Irvin (R-81st)
  • Rep. Warren Kampf (R-157th)
  • Rep. Ryan Mackenzie (R-134th)
  • Rep. Tedd Nesbit (R-8th)
  • Rep. Marguerite Quinn (R-143th)
  • Rep. Brad Roae (R-6th)
  • Rep. Justin Simmons (R-131st)
  • Rep. Curtis Sonney (R-4th)
  • Rep. Mike Tobash (R-125th)

Minority
 
  • Rep. Ryan Bizzarro (D-3rd)
  • Rep. Dom Costa (D-21st)
  • Rep. Margo Davidson (D-164th)
  • Rep. Tina Davis (D-141st)
  • Rep. Jason Dawkins (D-179th)
  • Rep. Michael Driscoll (D-173rd)
  • Rep. Marty Flynn (D-113th)
  • Rep. Ed Gainey (D-24th)
  • Rep. Robert Matzie (D-16th)
  • Rep. Perry Warren (D-31st)
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 Organizations supporting this initiative:

  • 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 Multiple Sclerosis Society
  • 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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