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The prior authorization saga in Illinois could be making some headway

Illinois is the latest state to call into question the concept or execution of prior authorizations, per an August 20 read.

Introducing our newest hero: Illinois Governor JB Pritzker, who is throwing out new legislation for the betterment of healthcare in Illinois. The motive: calling into question the concept or execution of prior authorizations.

According to a recent article in Modern Healthcare, health insurance companies in Illinois must comply with a new law governing prior authorizations for medical care.

What’s a prior authorization? It’s when your insurer insists on reviewing a course of treatment prescribed by your doctor before agreeing to cover it. Prior authorizations apply to medications, services, procedures—any kind of treatment.

And while carriers say it’s saving you money by “preventing care that you don’t need,” many patients feel like it’s just another way for insurers to find an excuse not to pay for what you do need.

We can’t help but agree.

Under the law, prior authorization programs can’t interfere with healthcare providers’ independent medical judgment. The article states: “The Prior Authorization Reform Act will become effective January 1, [2021] as a way to address dangerous delays in care, adverse health outcomes, and rising costs for necessary medical treatments.”

In addition, under the Prior Authorization Reform Act insurers must be transparent about their prior authorization rules. (Seems like a given, but insurers are not known to be so generous.) There are other transparency requirements under the law including timelines, what to do if they deny a claim, and more.

Bottom line: we support it.

The Prior Authorization Reform Act is a good thing because not only is it frustrating for patients—and potentially dangerous—when insurers delay care, according to a survey from the American Medical Association, medical practices also complete more than 29 prior authorization requests per week and spend nearly two full days per week processing them.

Many physicians (a whopping 92%) report that prior authorizations delay patients’ access to necessary care. The way we see it, care decisions should be made by clinicians— not “utility management” experts thousands of miles away.

Kudos to Illinois for stepping in with the new law, and for Governor Pritzker calling it like it is: “This legislation advances a key belief of mine that I know is shared by millions of residents in Illinois: Healthcare is a right, not a privilege,” he shares.

Now will the rest of our 50 states follow suit?

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