Make ‘prior authorization’ work for patients


 Charles Darwin wrote that “A man who dares to waste one hour of life has not discovered the value of life.”

No one knows the truth of this better than someone struggling with a serious illness, for whom every hour of life is hard-won. But all too often, sick people seeking medical care in Illinois must endure delays and denials. The culprit? Prior authorization approval requirements imposed by their health insurance plans.

Prior authorization means that health professionals must jump through extra hoops to get permission from payers to provide the care they believe their patients need.

This used to be a process that was used to prevent over-utilization of unnecessary testing. It’s now not functioning that way. It’s now become a cost management tool used by the insurance industry to reduce their cost or delay the payments they know they will eventually have to make.

We doctors are used to complexity and no strangers to paperwork, but any physician will tell you that prior authorization is one of the most frustrating parts of practicing medicine these days. A 2019 survey of more than 1,000 physicians conducted by the Illinois State Medical Society confirms this; nearly every respondent described a cumbersome, confusing, time-consuming, expensive process that lacks transparency.

More importantly, 95 percent of Illinois doctors reported that prior authorization harms their patients. Delaying medical care can allow diseases to progress, resulting in worse outcomes and making patients suffer unnecessarily.

Our patients should spend their time fighting their illnesses and living their lives, not waiting to find out whether their health insurance plan will allow them to do so.

Illinois physicians understand that your care can’t wait – and it’s time insurance companies understood this too. Common-sense reforms are needed to bring transparency, fairness and simplicity to prior authorization policies.

Together, we can fix prior authorization and make it work for our patients, friends, and neighbors. It’s about time.

Paul E. 

Pedersen, MD

President, Illinois State Medical Society