How Alabama residents can fight insurance red tape that delays medical care

Doctors and patients in Alabama frustrated by treatment delays caused by health insurance approval processes now have a new way to share their stories and create change.

A new online platform — www.ALFixPriorAuth.com – invites Alabama residents to share their experiences with prior authorization issues. The website and the initiative behind it to promote faster insurance authorizations for medical care were created by physicians from the Medical Association of the State of Alabama.

Doctors say prior authorization delays can have dangerous effects on their patients' health.

“Prior authorizations definitely cause delays in patient care,” said Dr. Tonya Bradley, a physician in Auburn. “I see delays in chemotherapy, I see delays in getting tests that are needed to diagnose problems that can be very urgent.”

What is prior authorization?

Before your doctor prescribes a treatment, your insurance company must prove that you need it. Decades ago, prior authorization was used sparingly and usually only to make sure some expensive treatment was absolutely necessary.

But today, even routine medical treatment requires the approval of health insurance companies. If treatment is refused, patients and doctors have to spend a lot of time battling with the health insurance companies to get their treatment.

Takes time away from what is really important

When doctors have to spend a lot of time arguing with insurance companies over prior authorizations, they have less time for their patients – their top priority.

“The bureaucracy. The paperwork. The institutional inertia. The list is endless and makes it very difficult for us to do what is really important, which is to take good care of our patients,” said Dr. George Koulianos of Mobile.

What people in Alabama think

A survey of physicians in Alabama found that 76 percent of doctors said they see fewer patients per day because of the time they spend on authorizations. A third of doctors said they and their staff spend nearly an entire workday per week filling out authorization forms, following up with phone calls and appealing denials.

A separate survey of 500 Alabama residents found that 80 percent agreed that “Alabama physicians are working to spend more time with patients so that patients and physicians can work together to make the best health care decisions.”

Dr. Hernando Carter said that spending more time with patients and eliminating the need to obtain authorizations would improve health care.

“If you can take the time to explain to your patient why you are recommending a test or treatment, and if you are able to answer all of their questions and allay any concerns or fears, then that has a direct impact on their condition. It has a direct impact on whether or not they get better,” said the Birmingham doctor. “That's why we abhor anything that detracts from or reduces the time we spend with our patients.”

“We need to be able to care for our patients efficiently, expedite treatment and not have all the red tape,” said Dr. William Admire of Mobile. “If we slow down the patient recovery process, nobody wins.”

Steps to resolve prior authorization

Doctors from the Medical Association have begun discussions with the health insurance community to push for change. Stories about www.ALFixPriorAuth.com will help support efforts to regulate prior authorization in Alabama.

Changes doctors are calling for include eliminating repeated prior authorizations for patients with chronic conditions and faster response times from insurers.

For more information, watch the video “Doctors Discuss the Burdens of Prior Authorization” here.