Two of the biggest issues facing the average person in acquiring healthcare are cost and access. Not everyone has medical insurance, and those who do aren’t always widely insured. This issue becomes even worse when more select procedures are necessary. If there are no guidelines for a specific service, providers have to obtain authorization to have it ensured.
This process of getting permission from an insurer to cover a service is called prior authorization. It’s a process which is meant to save money for companies without having to regulate every possible healthcare service. And while it makes sense in concept, in reality it has become a huge administrative time sink for healthcare workers.
Healthcare providers losing time on prior authorization is particularly harmful due to the rampant staffing shortages in the industry. Manually submitting a prior authorization request is tedious, time consuming, and at times, frustrating. 35% of providers end up just hiring a staff member explicitly to take care of prior authorization requests.
While this saves the healthcare provider some time, it loses them money. Even more importantly, if they can’t afford a staff member, these requests can quickly become overwhelming. In the worst cases this leads to requests being denied, which leads to patients not getting coverage or care.
This turns what started as an insurance issue into something which can cost patients their lives. That is the importance of prior authorization. Fortunately, in the modern day prior authorization process automation solutions are popping up. Instead of exhausting time and resources on submission, AI can search files, make calls, and submit the request itself. In the long run this saves everybody time, money, and potentially their lives.
Ultimately prior authorization is just one example of how administrative burden can significantly change quality of care. It’s important because of the effects it has on patients and providers. There are many services which require prior authorization. Ensuring that the process is as easy and quick as possible is an important goal for reducing healthcare inefficiency.
Source: Orbit Healthcare
