In the third episode of the HEALTH CARE un-covered Show, we’re joined by Dr. Wendy Dean, co-founder of Moral Injury of Healthcare; Dr. Seth Glickman, a former health system executive; and Congresswoman Suzan DelBene, who represents Washington’s 1st District, to discuss prior authorization and the toll it takes on patients, providers – and now, taxpayers.
As regular readers of this newsletter know (or if you’ve been unlucky enough to deal with this bureaucratic hurdle yourself) prior authorization is the process insurers use to approve (or deny) coverage for care before a patient can receive it. In theory, it’s about preventing unnecessary treatment. In practice, it often functions as a cost-control tool that delays care, overrides doctors’ medical judgment, and leaves patients stuck in limbo.
We also unpack CMS’s new WISeR Model, a pilot that has brought more prior authorization – with help from artificial intelligence – into traditional Medicare. The pitch is efficiency. The concern is that it could import the worst aspects of Medicare Advantage into the program.
Unnecessary prior authorization exhausts doctors, harm patients and create life-or-death delays… all while helping insurers protect their bottom lines.
