On May 16, The Lincoln Star published an op-ed titled “When Insurance Fails” by neurosurgeon Jeremy Hosein, MD. The op-ed discusses the misuse of prior authorization, which delays care, prolongs suffering and adds significant administrative costs to health care.
According to Dr. Hosein, prior authorization is increasingly used to deny or delay basic medical care such as blood tests, imaging and other medically necessary procedures. A 2023 Kaiser Family Foundation analysis found that 82% of appeals in Medicare Advantage resulted in overturned denials. Fortunately, some hope may be on the horizon, states Dr. Hosein. The Centers for Medicare & Medicaid Services (CMS) issued rules to increase transparency and reduce the burden of prior authorization with an automated electronic process.
Click here to read the op-ed and here to read more about CMS’ proposed rules.
