Skip to Content

Death by 1,000 prior authorizations

Radiology Business’ April 5 story shares a warning regarding United’s latest round of prior authorization requirements.

Providers hoping to treat their patients with radiation therapy may want to add some extra hours to their billing departments’ budgets. (And while they’re at it, they might consider prescribing them some extra-strength antacid.)

We’ve talked a lot about UnitedHealthcare denying claims from practices that don’t obtain prior authorization, including a lawsuit filed against United for allegedly refusing to cover cancer patients’ proton beam radiation therapy because of its price tag.

Now, United seems to be doubling down on this behavior and saddling physicians with yet more paperwork to try to get payments for outpatient services they deliver to their patients—and, at the same time, stifling their ability to get treatments to patients. The new restrictions include imaging-guided radiation therapy and fractionation for a number of treatments, and requirements for prior authorization for therapies such as stereotactic body radiation therapy and fractionation for breast, prostate, lung, and bone metastasis cancer.

There are numerous downsides, and yes, dangers, to burdensome prior authorization processes like these, especially when it comes to cancer treatment. The top concerns we see are:
1. Delays to patients’ treatment, leading to worse outcomes
2. Hours lost fighting for patients to get the care they believe is necessary, detracting from physicians’ time providing care
3. Threats to doctor-patient relationships, as patients can’t get treatments that their doctors deem best

We’re concerned that this prior authorization trend could be picking up steam, now that a precedent has been set. It will be interesting to see whether it’s received as de rigueur or déclassé.

Original Article:

Subscribe to Un-covered Essentials

Insurer policies limit coverage and disrupt patient care, while producing record profits for corporate shareholders. Stay informed with the Un-covered newsletter.