Getting the health insurer’s approval for treatment often takes more time than cancer patients can spare.
Health insurance hurdles delay care for two-thirds of cancer patients, a survey from the Association for Clinical Oncology explains. And the delays, which are due to health plans’ prior authorization requirements, can last up to two weeks.
Treatment Delays and Health Consequences
In another survey, 93% of responding radiation oncologists said that insurance requirements delayed life-saving treatment. The American Society for Radiation Oncology, which conducted the survey, has published a number of open letters challenging inappropriate health plan denials of authorization. The group also advocates to ensure that patients, especially those treated through Medicare and Medicaid, have access to timely care.
Requiring medical treatment to be approved in advance can help ensure that patients get appropriate care. But prior authorization requirements are now so common that they stand in the way of patients receiving urgent treatment for serious conditions.
A single day of delay in cancer treatment may increase the likelihood of death by up to 3%. A month’s delay raises the risk of dying by 10%, and the risk continues to rise the longer treatment is delayed.
Adding insult to injury, claims that are initially denied frequently get approved upon appeal. In other words, denials often function as delay tactics rather than medically necessary safeguards. And patients pay the price. Even when barriers to care can be promptly resolved, they introduce uncertainty, anxiety, and additional paperwork into an already stressful time in a cancer patient’s life.
Clinic Hours Lost on Red Tape
Onerous prior authorization also weighs on the clinics dedicated to treating cancer patients.
In the survey conducted by the Association for Clinical Oncology, more than 50% of participating oncology practices had dedicated support staff that worked exclusively on prior authorization.
And nearly half reported spending more than 40 hours a week on prior authorization paperwork alone.
Prior authorizations attempt to reduce health care costs for insurers. But they instead introduce significant costs – in terms of time, health and quality of life – for providers and patients.