Providers say prior authorization creates barriers to care. Bill aims to limit its usage

Insurance companies may require pre-approval for medical services before they will cover it. This is what’s known as prior authorization. A Senate committee moved a bill forward that would limit the use of prior authorization.

Senate Bill 3 would ban prior authorization for routine and emergency services, and common prescription drugs. It also puts limits on both the amount of prior authorizations insurers can require, and the time it takes to approve services.

One of the bill's authors, Sen. Tyler Johnson (R-Leo), said prior authorization creates a barrier to patients getting care and adds administrative costs to the health care system.

“We're just adding more and more costs to health care with all these things while people are screaming,” Johnson said.

Dr. Elizabeth Struble, a family practice physician in rural Indiana, said patient condition can worsen while waiting for approval which can lead to more expensive care in the long run.

“There always seems to be other people in the middle that are not me or my patient, and what I know is best for my patient,” Struble said.
 

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Struble said prior authorizations put the administrative burden on the providers.

Opponents of the bill say prior authorization can be a tool to control the cost of health care.

Blair Hadley, the director of government relations at the Insurance Institute of Indiana, said prior authorizations are a “quality and safety assurance” process that stakeholders want to work to improve with the general assembly.

“We know prior authorization is not a perfect process as it exists today, and we know that there are opportunities for changes to be made,” Hadley said.

The bill was a part of the Senate Republican caucus’s session agenda, and was unanimously passed through the Senate Health and Provider Services Committee.
 

Abigail is our health reporter. Contact them at aruhman@wboi.org.