Prior authorization is a process that doctors have to go through to get prior approval from an insurance company to provide a service to their patients.
A lot of procedures currently requiring prior authorization do not need it. Sometimes issues with this process can even cause delayed treatments and malpractice.
How long does it take to get prior authorization?
Prior authorization can take anywhere from one day to a month, depending on the request. However, about one-quarter of cases take more than three days for a decision.
How do patients get it?
In-network doctors start the prior authorization process for their patients. If patients choose to visit doctors outside of their network, the patient must begin the process. Without authorization, patients are subject to their insurance company refusing to pay for treatments and medications, which can cause them to have more out-of-pocket costs.
How does the process work?
Whoever is responsible starts the process. After that, patients can expect to hear from their insurance company with one of the following decisions:
- They approve the treatment
- They decline the treatment
- They request more information
Sometimes, insurance companies may also request a patient receive a cheaper, equally effective option.
Can it cause medical malpractice issues?
Prior authorization can take a lot of time, and problems can cause unnecessary delays. That can cause medical malpractice issues for patients.
One little mistake in this process can cause a delay that seriously injures a patient. In this case, patients could have a medical malpractice lawsuit.