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What is prior authorization?

| Dec 25, 2018 | Firm News, personal injury

Tactics that insurance companies use to cut their operating costs are known to add burdens to Kentucky policy holders who are seeking treatment for personal injuries. Fail first options are one such tactic, but insurers can delay a person’s efforts to receive coverage for their treatments in other ways. One of these methods is known as prior authorization.

According to the American Medical Association, insurance companies will not automatically cover prescription drugs that a policy holder may need for treatment. In some cases, a doctor has to fill out a prior authorization request for the drug and send it to the insurer before the insurance company will cover the drug. Generally, insurers have used PAs as a way to help review a treatment or a medication that is new or very expensive and ensure that it is appropriate for a patient to use.

Recently, the problem with prior authorization is that insurers are increasingly adding PA requirements to more and more drugs. Doctors are finding they have to fill out prior authorizations not just for new treatments, but for generic drugs that have been available for decades. In addition, physicians may discover that they also have to fill out a PA for every treatment option they offer a patient.

Even though many PA requests are ultimately approved, the paperwork needed to fill out a PA takes valuable time away from the doctor. And if the PA is rejected, the doctor and the doctor’s staff have to file an appeal on the matter. These bureaucratic hurdles delay patients from receiving their needed drugs and also occupy the time of doctors who could be using it with their patients.

If you are injured, you need the best quality care possible. Unfortunately, medical insurers are not always quick to provide the coverage injury victims need for their treatment. You may need to seek consultation from a personal injury attorney if you suspect an insurer is unfairly slow walking your medical coverage.

Be aware that since personal injury claims take many forms, this article should not be considered as legal advice. Its purpose is to inform the reader on personal injury topics.