Prior authorization has long caused professional strife for Dr. Zeke Silva, a San Antonio-based radiologist. But last year it became personal.
His wife had breast cancer, and her doctors wanted to schedule a MRI. Their insurer denied the request. She eventually got the procedure approved, but it was delayed.
Silva hopes to see these situations less now that Texas passed a statewide prior authorization “gold card” law. The measure requires insurers to exempt providers from pre-authorization for certain services if they achieve a 90% approval rate for the service over six months.
“I’m looking forward to a time where, because of that gold carding status and satisfying that 90% threshold, that I can look a patient in the eye and tell them confidently ‘This is what I’m recommending. … Oh, and by the way, you and I don’t have to go through a prior authorization process to make this happen,’ ” Silva said.
Nearly 90% of providers said prior authorization felt very burdensome, according to a 2021 Medical Group Management Association survey. And it’s not just a burden issue—24% of physicians surveyed by the American Medical Association last year said their patients often abandon care after facing pre-authorization.