Insurance delays hurt patients and doctors, but Congress can fix it

Patients are experiencing delays in care, and insurers are driving the delays, which ultimately hurt patients and hand-cuff doctors.

Jonathan R. Crowe, MD, MPH, MSc is a resident physician in the Mass General Brigham Neurology Residency Program at Massachusetts General Hospital and Brigham and Women’s Hospital.

Delays like this come from an extra step in the insurance approval process called "prior authorization," where a health care plan needs to approve a medicine or therapy before a patient receives it. This is different from the normal way that a doctor prescribes a medicine to a patient when the patient simply picks the medicine up at the pharmacy. If it turns out that the insurer requires a prior authorization, doctors often must go through a long process that requires filling out extensive paperwork, faxing it to insurers, making multiple phone calls, and spending increasing amount of time talking with insurers instead of patients.

The process for approval commonly lasts several days to weeks, and it is not without negative consequences. A 2021 survey by the American Medical Association found that 93 percent of physicians reported that prior authorization can delay access to necessary care. More than1 in 3 physicians report that prior authorization led to a serious negative health event for their patients, including death.