Prior authorization is a key component of health insurance, but it has not always been the enormous hurdle that it is today. Health insurance companies require prior authorization for some of the most routine aspects of health care, such as filling prescriptions. Until significant changes are made to insurance law, Washington patients will still need to understand the role that prior authorization plays in their health as well as their rights when fighting the insurance companies.
Insurance companies originally used prior authorization to make sure that high-cost procedures and hospitalizations were appropriate. Now, prior authorization seems like little more than a tool for cutting costs at the expense of patient health. People living with diabetes now need to routinely seek prior authorization for medication, as do patients with mental illnesses like bipolar disorder.
But prior authorization does not appear to be helping anyone in this situation. For example, when insurance companies require prior authorization for medications used for diabetes, bipolar disorder, schizophrenia and depression, it actually leads to higher overall costs. Prior authorization has also been linked to worsening status and more hospitalizations among patients with these illnesses.
Many experts in the medical community would like to see changes to insurance law that would limit how companies use prior authorization. Unfortunately, there seems to be little change on the horizon. Until then, patients in Washington should do their very best to understand the terms of their insurance policies, the methods for filing appeals and approaches for holding insurance companies responsible for their actions.