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Prior authorization has become a chronic pain point for patients and doctors

KFF Health News
Summary
Nutrition label

75% Informative

Sheldon Ekirch , 30 , was diagnosed with small fiber neuropathy, a condition that makes her limbs and muscles feel as if they're on fire.

She takes more than a dozen prescriptions to manage chronic pain and other symptoms, including insomnia.

Her insurance company has repeatedly denied coverage for the treatment, documents show.

Many states have passed legislation to regulate the use of prior authorization.

Reform bills are under consideration by state legislatures in Hawaii , Montana , and elsewhere.

Some doctors and advocates for patients are skeptical that prior authorization can be fixed as long as insurers are accountable to shareholders.

Cigna Group CEO David Cordani said he is focused on “making prior authorizations faster and simpler”.

In 2023 , virtually all Medicare Advantage enrollees were covered by plans that required prior authorization.

People enrolled in traditional Medicare were much less likely to face prior authorization for higher-cost services.

But UnitedHealthcare says prior authorization rules apply to fewer than 2% of the claims the company pays.

VR Score

75

Informative language

79

Neutral language

36

Article tone

semi-formal

Language

English

Language complexity

62

Offensive language

not offensive

Hate speech

not hateful

Attention-grabbing headline

detected

Known propaganda techniques

not detected

Time-value

short-lived

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