PRIOR AUTHORIZATION SURVEY
TOP-LINE RESULTS
Patient Access to Care Has Been Impacted
- Eighty-two percent of respondents state that prior authorization either always (34%) or often (49%) delays access to necessary care.
- The wait time for prior authorization can be lengthy. For most neurosurgeons (67%) it take between 2 to 14 days to obtain prior authorization, but for 22%, this process can take from 15 to more than 31 days.
- Prior authorization causes patients to abandon treatment altogether with 21% reporting that patients often abandon treatment and 60% reporting that patients sometimes abandon treatment.
- Overwhelmingly (88%), neurosurgeons report that prior authorization has a significant (37%) or somewhat (51%) negative impact on patient clinical outcomes.
Prior Authorization Burden Has Increased
- Ninety-one percent of neurosurgeons report that the burden associated with prior authorization has significantly increased over the past five years.
- Insurers have increased the use of prior authorization over the past years for procedures (95%); for diagnostic tools (93%); and for prescription medications (55%).
- The burden associated with prior authorization for neurosurgeons and their staff is high or extremely high (95%).
- In any given week, most neurosurgeons (41%) must contend with between 11 and 40 prior authorizations. More than one-quarter (27%) of respondents face more than 40 per week.
- Many neurosurgeons must now engage in the so-called peer-to-peer process to obtain prior authorization, and nearly one-third (32%) of respondents experience this requirement for 26 to 75% or more of their services (including prescription drugs, diagnostic tests and medical services).
- Ultimately, the majority of services are approved (80%), with nearly forty percent (39%) of neurosurgeons getting approved 90% or more of the time.
- Unbelievably, despite gaining prior authorization, insurance companies deny payment after services are rendered, an outcome three-fifths of neurosurgeons have experienced more than once in the past year, and 24% have had this happen 20 or more times.
- More than three-fifths (62%) of neurosurgeons have staff members working exclusively on prior authorization, with most staff spending between 10-20 hours per week on prior authorization.
- Most plans employ prior authorization, although UnitedHealthcare (72%), Blue Cross Blue Shield (72%) and Aetna 68%) are the top utilizers.
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