Why Reform Prior Authorization?
We've All Felt It. Every one of us, or someone we love, has had a hard time because of something called "prior authorization" in healthcare.
It's NOT Fair: Most of the time, prior authorization is just a hassle - it's costly, complicated, and often unnecessary.
A Deliberate Delay: Health insurance companies use prior authorization to slow down or even stop you from getting the medical care you need.
Profit Over People: Insurance companies use this process to save money for themselves, not to help you, even if it means you might not get the treatment you need.
This isn't a Game: Your health isn't something to play with. When insurance companies delay or deny treatment, they're messing with people's lives.
Who's Really Paying?: Insurance companies aren't really paying for your healthcare; they're just in the middle, processing payments. You, the patient, are the one truly paying for your health care.
Sign our petition to tell the North Carolina General Assembly, the time is NOW to pass Prior Authorization Reform.
We, the undersigned, respectfully urge the North Carolina General Assembly to take swift and decisive action to reform the prior authorization process in order to improve patient access to essential medical care and enhance the overall quality of healthcare in our state. We believe these changes will ensure that all patients receive timely, effective, and appropriate care, and that insurance companies follow fair, transparent, and patient-centered practices.
The following reforms to the prior authorization process are urgently needed:
- Minimum Standards for Clinical Review Criteria: Require insurers to update clinical review criteria annually and set minimum clinical standards to ensure timely access to the most appropriate treatments.
- Physician Involvement in Decision-Making: Insurers must consult with the patient’s physician before denying coverage, ensuring medical decisions prioritize patient health.
- Timely Decisions: Set clear time frames for prior authorization decisions based on the urgency of the medical need, ensuring prompt access to care.
- Continuity of Care: Insurers must ensure continuous care for patients, especially during transitions between providers or plans, to avoid gaps in treatment.
- Limits on Retrospective Denials: Prevent insurers from denying payment for services approved within 45 days of initial authorization.
- Clear and Accessible Plan Language: Insurers must make prior authorization criteria and processes easy to understand and publicly accessible for patients and healthcare providers.
We strongly believe that these reforms will improve patient care and physician-patient relationship. The current system often leads to delays in treatment, frustration for both patients and healthcare providers, and additional costs. By enacting these reforms, the North Carolina General Assembly will create a more efficient, transparent, and patient-centered healthcare system.
We respectfully urge the members of the General Assembly to prioritize these reforms and work toward a future where patients’ healthcare needs are met promptly, efficiently, and fairly.