Dr. Holland, who said he does not use electronic platforms for prior authorization, is skeptical of any suggestions made by the insurance industry. “They’re largely the ones putting up these hurdles anyway,” he said. “Prior authorization is purely a burden put in place to discourage consumption.”
Explore This Issue
November 2023David Zeman, ENT and Allergy’s chief strategy officer, said it isn’t all that surprising that insurance companies are requesting prior authorization for more types of procedures.
“As the medical industry overall, and otolaryngology specifically, have evolved and shifted from more cases being done in the hospital to more procedures being done in the office setting, insurance carriers have evolved in pace with that,” he said. “They continue to not have to pay when they don’t need to or want to. And so, they’ll jump to their medical policies to require these approvals for even minor procedures done in the office. That’s challenging whether I’m a physician, in the back office, or a patient, because it causes unnecessary delays and grief.”
But he said it’s in the interest of physicians and practice managers to work with insurance companies as well as they can. “What I find to be important is working as closely as you can with the payer and your counterparts at these carriers to understand the nuances of their medical policy and what they will and will not require authorization for,” he said. “You choose how you want to approach these conversations. Some people like to be firm, and there is a time for being firm, protective, and supportive of your own patients and practice. But at the end of the day, you have to work with these people, and you want to create partnerships that are long-lasting.”
Thomas R. Collins is a freelance medical writer based in Florida.
The Push for Change
What to do about prior authorizations?
It’s a question that preoccupies otolaryngologists and practice managers, with insurance carriers requiring pre-approval for coverage of many more types of procedures and with reviews of certain cases becoming more complicated.
In addition to using electronic platforms to make requests, submit documentation, and track requests, however, other electronic options are emerging to make the process more reasonable.
Bradford Holland, MD, an otolaryngologist in Waco, Texas, helped support an effort to have a Gold Card program established by the state legislature. In the program, physicians who had a prior success rate of at least 90% in getting prior authorization requests approved over a certain period of time—indicating that their requests for coverage were sound—could bypass prior authorization.