Preauthorization

Abstract

Purpose of Review

The goal herein is to discuss preauthorization for U.S. diagnostic and therapeutic interventions and ascertain the benefits and adverse events associated with it. Preauthorization is the process of requiring a physician to obtain permission from a healthcare insurer to perform a diagnostic or therapeutic procedure.

Recent Findings

Preauthorization is widespread across health insurers, with the average physician performing 37 per week. The process occupies 20 h/week for the average physician and/or staff, for which there is no compensation for excess time spent. The mean cost of interacting with insurers has been estimated to be $83,000 per physician per year. Approximately 79% of preauthorizations are eventually approved, with 72% approved on initial submission and 7% on subsequent submissions. In one poll, 94% of physicians thought preauthorizations were never or almost never appropriate. The AMA has suggested simplification, standardization of forms among insurers, insurer response within 2 days, fair compensation for the process, and transparency, accessibility and consistent application of requirements. Other methods of healthcare cost saving may be superior to preauthorization.

Summary

Preauthorizations place considerable financial and time burdens on physicians and their practices. An overwhelming percent of physicians believe they are unnecessary, and even insurers admit that they are utilized in instances to keep down the costs of healthcare.

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Correspondence to Gary C. Brown.

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This article is part of the Topical Collection on Ocular Microbiology and Immunology

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Brown, G.C., Brown, M.M. Preauthorization. Curr Ophthalmol Rep 6, 181–190 (2018). https://doi.org/10.1007/s40135-018-0182-3

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Keywords

  • Preauthorization
  • Precertification
  • Prior authorization
  • Provider time and cost burden
  • Purpose
  • Patient benefit