Coalition working to ‘Fix Prior Authorization’ in Alabama grows

MONTGOMERY – The “Fix Prior Authorization” campaign, launched in August by doctors with the Medical Association of the State of Alabama, is challenging these insurance requirements that can cause patients to wait days, weeks or even months for necessary care.

According to the Alabama Department of Insurance, prior authorization checks that your plan covers the proposed care. It’s also a way the health plan can decide if the care is medically necessary, safe and cost effective.

Now 30 Alabama healthcare groups have united to fight what they say are “harmful insurance delays.”

In a statement released by the coalition, numerous healthcare professionals provided first-hand accounts of their experiences treating patients.  

“We can no longer let paperwork and red tape stand in the way of effective medical care. Patients like mine deserve better,” said Dr. William Kilgo, Director of the Neuroimmunology and MS Clinic at USA Health in Mobile.   

Kilgo said one of his patients with multiple sclerosis saw her condition worsen while waiting for her insurance company to approve the medication she needed to keep her MS under control.

The patient went from being able to walk and manage her disease to needing a wheelchair because of the delay, said Kilgo.

“She had gone from being ambulatory and managing her disease to facing a life forever altered by this unnecessary and infuriating delay in her care because of prior authorization requirements,” he said.

The coalition contends that prior authorizations were once reserved for high-cost treatments, but today, even routine care can be delayed or denied because of these insurance requirements.

“The problem is it has now morphed into requiring paperwork for very routine medications, routine imaging, routine care and it causes significant delays in treatment,” said Dr. Amanda Williams, president of the Medical Association and a psychiatrist in Montgomery. “Usually, it can take days to get a response and often it will just be a denial and require an appeal and then take even longer.”

Dr. Harry J. McCarty, Alliance Cancer Care of Huntsville, also offered his statement in support of fixing prior authorizations.   

“As physicians, we want to provide the highest quality care modern medicine can provide…What we are encountering, however, is a level of scrutiny so severe – and a system so difficult to work within – that it becomes almost impossible to provide excellent patient care.  There is literally almost nothing in medicine that is a bigger impediment to patient care than these barriers put up by the very health plans that are supposed to be helping us serve our patients,” said McCarty.  

The coalition is urging Alabamians who experience delays in treatment to share their stories at www.ALFixPriorAuth.com.  The coalition is meeting with health insurers to push for changes. Stories submitted through www.ALFixPriorAuth.com will help support these efforts to fix prior authorization in Alabama.

The 30 Alabama organizations in the coalition are:

Alabama Academy of Eye Physicians and Surgeons

Alabama Academy of Family Physicians

Alabama Academy of Neurology

Alabama Cancer Congress

Alabama Chapter of the American Academy of Pediatrics

Alabama Chapter of the American College of Cardiology

Alabama Chapter of the American College of Emergency Physicians

Alabama Chapter of the American College of Physicians

Alabama Chapter of the American College of Surgeons

Alabama Dermatology Society

Alabama Gastroenterological Society

Alabama Medical Directors Association

Alabama Orthopaedic Society

Alabama Primary Healthcare Association

Alabama Psychiatric Physicians Association

Alabama Rare

Alabama Section of the American College of Obstetricians and Gynecologists

Alabama Society of Addiction Medicine

Alabama Society of Allergy, Asthma and Immunology

Alabama Society of Anesthesiologists

Alabama Society of Otolaryngology, Head and Neck Surgery

Alabama Society of the Rheumatic Diseases

Alabama Urology Network

Aledade

American College of Nurse Midwives

Five Horizons Health Services

Healthcare Leaders Association of Alabama

Medical Association of the State of Alabama

Neurological Society of Alabama

Nurse Practitioners Alliance of Alabama