Around 6 in 10 adults have experienced problems with their health insurance, according to a Sept. 29 report from KFF, with several problems linked to prior authorization delays and denials from payers.
The report surveyed insured adults who have faced prior authorization delays or denials in the last year. Here are seven things to know about persistent prior authorization issues:
1. Sixteen percent of all insured adults have faced prior authorization issues in the last year, and certain characteristics make denials or delays more likely.
2. About 22 percent of adults with Medicaid experienced prior authorization issues, compared to 11 percent with Medicare and 15 percent with employer-sponsored coverage.
3. Adults who visit physicians more frequently are more likely to experience prior authorization problems. Those who have visited more than 10 times in the past year face a 31 percent delay or denial rate, compared to those with three to 10 visits (20 percent) and those with two or fewer visits (10 percent).
4. Some patients who use certain types of services or who have certain conditions experienced more delays and denials, though KFF noted the survey data doesn't show if prior authorization applied to these services or conditions. Twenty-six percent of patients who sought treatment for a mental health condition faced delays or denials, compared to 13 percent of those who did not.
5. Twenty-three percent of patients who sought treatments for diabetes faced denials or delays, compared to 14 percent of other insured adults.
6. Nineteen percent of adults who take at least one prescription medication experience problems, compared to 8 percent of those who don't.
7. Adults who received care in an emergency room in the last year were twice as likely to experience prior authorization problems.