Medical providers are doing everything possible to fight the coronavirus pandemic.
“We’re seeing the incredible commitment of doctors, nurses and other care providers during this public health crisis,” says Terry Wilcox, executive director of Patients Rising, a national patient advocacy non-profit organization. “They’re risking their own health and safety to provide care to patients.”
As doctors work long hours and pull double shifts, they’re discovering an increased demand on their time from a familiar foe: insurance barriers.
Terry Wilcox, executive director of Patients Rising
“Overburdened physicians now have even more time commitments. Yet in the middle of a global pandemic we’re being asked to fill out paperwork,” Dr. Robert Fekete, M.D., a neurologist in New York, tells the Alliance for Patient Access.
One of the most common insurance barriers overburdening doctors right now is prior authorization. The insurance barrier requires patients to obtain special permission from the insurance company before a patient can access the treatment prescribed by her doctor. Without prior authorization approval, the treatment won’t be covered by insurance.
“Insurance companies never examine you, but they have veto power over your doctor’s decisions,” explains Wilcox of Patients Rising.
Prior Authorization: Bad for Patients
Often times, patients waiting for insurance approval suffer in pain or experience worsening symptoms. Medical providers working to avoid these negative patient outcomes are left with tight deadlines and strict demands from insurance companies.
Dr. Fekete describes one recent case in which a patient with essential tremor was forced to go through the insurance prior authorization process.
“The form said I needed to respond within six hours. Six. It had a little picture of a clock on it,” Dr. Fekete recalls.
In between inpatient schedule changes and his facility’s social distancing training, Dr. Fekete caught the form and responded in time.
“The insurer’s preferred drug is in a completely different class and has side effects like kidney stones and interference with birth control,” he says. “If the switch had happened, it could have been bad.”
More ER Visits, More Opportunities for Coronavirus Exposure
Patient advocates point out that prior authorization requirements can mean more trips to the doctor’s office. In some cases, the wrong treatment can mean more severe symptoms that require hospitalization or a visit to an emergency room, both of which bring increased risk of exposure to the coronavirus
“Patients, especially those at a heightened risk of more severe outcomes from COVID-19, need access to the right treatment when their doctor prescribes it,” says Wilcox of Patients Rising.
To protect patients and reduce the burdens on doctors, Patients Rising NOW has joined a patient advocacy coalition urging states to prevent health insurers from imposing prior authorization requirements for the duration of the public health crisis.
Led by Aimed Alliance, more than a dozen non-profit organizations, including Chronic Disease Coalition, Conquer Myasthenia Gravis, Cured Foundation, Headache and Migraine Policy Forum, Lupus and Allied Diseases Association and the American Brain Coalition, have joined the effort.
“We need doctors and nurses caring for patients, not busy with insurance paperwork,” says Wilcox of Patients Rising.
Read Patients Rising NOW’s letter urging states to prevent insurance companies from imposing prior authorization requirements during the COVID-19 pandemic.
Watch: Alliance for Patient Access Explains Prior Authorization
