Bill in Harrisburg could change how insurance prior authorization works for you
By: KDKA-TV's Seth Kaplan
HARRISBURG, Pa. (KDKA) — Have you ever wondered who's controlling your medical care: your doctor or your insurance company?
It's common practice for health insurance companies to require prior authorization before approving a medical procedure. But how that authorization happens could soon change.
Chip Hummer, a Philadelphia-area surgeon who's been leading the statewide effort, has one complaint.
"An awful lot of time seeking approval for medically necessary care," Hummer said.
Time is money.
"And that's not money that's being spent on patient care," the doctor said.
Because of required insurance prior authorizations. Hummer says part of the problem is who's making the decision.
"It's common that I'm speaking to a physician who may not even know the terms I'm using because they're not in the field of orthopedics," Hummer said. 'They're in another specialty."
So, if prior authorization is so bad, what was the point of it in the first place? Actually, both sides, or at least both of what were different sides on this issue, say it exists for a reason.
"Prior authorization has proven to be very helpful in terms of making sure that you're avoiding unnecessary procedures, unnecessary medications, conflicting medications," said Sam Marshall, chief counsel of the Insurance Institute of Pennsylvania.
A bill making its way through the Pennsylvania House could potentially solve some of the issues with prior authorization as it now stands. Among other things, it would give insurers more specific deadlines to make decisions and make sure doctors talk to the correct people at the insurance company.
"It would be true peer-to-peer interaction so that the decision maker on the insurance company side would be able to make an educated decision," Hummer said.
The bill already has support from doctors and insurers. It passed in the state Senate and has a good chance of passing in the House this week and becoming law.