Burden with No Benefit: Prior Authorization in Congenital Cardiology.
Pediatr Cardiol
; 45(1): 100-106, 2024 Jan.
Article
en En
| MEDLINE
| ID: mdl-37750969
ABSTRACT
Prior authorization is a process that health insurance companies use to determine if a patient's health insurance will cover certain medical treatments, procedures, or medications. Prior authorization requests are common in adult congenital and pediatric cardiology (ACPC) due to need for advanced diagnostics, complex procedures, disease-specific medications, and the heterogeneity of the ACPC population. Prior authorizations in ACPC are rarely denied, but nonetheless, they are often accompanied by significant administrative burden on clinical care teams and delays in patient care. Prior authorizations have been implicated in worsening care inequities. The prior authorization process is insurer specific with differences between commercial and public insurers. Prior authorization rejections were previously found to be more common for women, racial minorities, those with low education, and in low-income groups. Prior authorization unduly burdens routine diagnostics, routine interventional and surgical procedures, and routine cardiac specific medication use in the ACPC population. This manuscript highlights the burdens of prior authorization and advocates for the elimination of prior authorization for ACPC patients.
Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Cardiología
/
Autorización Previa
Límite:
Adult
/
Child
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Female
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Humans
Idioma:
En
Revista:
Pediatr Cardiol
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos