The Alabama Medical Association this week announced an effort to enlist the help of the state Legislature to reduce prior authorization delays.

Alabama doctors say new federal rules could help patients in government-sponsored health programs receive more timely treatment, but they do not apply to private insurance plans. State legislatures still need to act.

of new rules The program, created by the U.S. Centers for Medicare and Medicaid Services, is intended to streamline the use of pre-authorization health plans, which require doctors and patients to first obtain insurance company approval before receiving treatment prescribed by a doctor. .

Under this rule, health insurers participating in Medicare Advantage, Medicaid, and Children's Health Insurance Program (CHIP) must respond promptly to prior authorization requests and include specific reasons for denying the request. .

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Dr. George Koulianos is a traveling physician who serves as president of the Alabama Medical Association.

“Prior authorization is a bureaucratic mess, and patients pay the price. Seriously ill patients are left waiting days or even weeks to get approval from their insurance company to begin treatment. Imagine,” Dr. Koulianos said this week.

“Imagine having to hire multiple back-office personnel just to manage the burden imposed by insurance companies. We're overwhelmed with red tape. This new federal rule is a step forward, but it's just a small step. It protects patients and allows doctors to see more patients instead of spending time buried in red tape. We need strong action at the state level to reform prior authorization.”

american medical association A recent survey revealed Doctors are concerned that prior authorization requirements will delay necessary treatment. One-third of physicians report that they and their clinical staff spend nearly an entire day each week obtaining prior approvals.

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76% of physicians said that the longer pre-approval times would result in seeing fewer patients per day, reducing patient access to care. They say the time and energy doctors have to spend dealing with health bureaucracies contributes to health professional burnout. Alabama already has a shortage of doctors, especially in rural areas of the state.

“There is no question that prior authorization delays patient care, causes physician burnout, and increases overall health care costs,” Dr. Koulianos said. “With a growing physician shortage, we must do everything we can to maintain our physician workforce, including reforming our cumbersome prior authorization process.”

The 2024 Alabama regular legislative session begins on Tuesday, February 6th.

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