Nearly 1 in 5 consumers with health insurance report that their insurer delayed or denied care due to prior authorization requirements, a process through which insurers can require patients to obtain approval in advance before they will cover specific services. Insurers argue that prior authorization is a tool to limit unnecessary and ineffective care, thus reducing costs. However, there are concerns that it creates unreasonable barriers for patients seeking needed care and imposes excessive paperwork burdens on doctors and other providers.
To address these concerns, federal regulators have finalized new rules governing how insurers use prior authorization for Medicare Advantage, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act’s federal Marketplace plans. Meanwhile, lawmakers are considering broader legislation. On Thursday, February 22 at noon ET, a panel of four experts will join Larry Levitt of KFF’s executive vice president for health policy for a 45-minute discussion on the future of prior authorization requirements in healthcare. The panelists will examine why insurers use prior authorization, its impact on patients and providers, and how the new regulations may change current practices. They will also discuss potential regulatory or legislative actions to address ongoing concerns about prior authorization’s use in healthcare.
The virtual Health Wonk Shop series from KFF features expert discussions beyond news headlines that provide greater insights into policy issues. This event takes place on February 22nd at noon ET .