Prior Authorization

Photo by National Cancer Institute on Unsplash

Prior authorization is a requirement by insurers that you and/or your health care provider get prior permission to do a procedure or provide certain medications or the insurer may not pay for it. This has been particularly true for people on Medicare Advantage, the alternative to traditional Medicare. But now commercial insurers outside of the Medicare program are using prior authorization as a way to reduce what they spend on your care, but it can potentially delay or deny the care you need when you need it. The burden of prior authorization on patients, clinicians and healthcare organizations has led some health systems to refuse to accept patients covered by a Medicare Advantage plan. HealthCetera host Dr. Diana Mason, RN, discussed prior authorization with Dr. Eli Cahan, MD, a journalist and resident at Boston Children’s Hospital who wrote about it in the August 30, 2024, issue of JAMA. This interview first aired on HealthCetera in the Catskills on WIOX Radio on September 11, 2024. 

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Photo by National Cancer Institute on Unsplash Prior