Bramnick pens op-ed critical of insurance pre-approval requirements

Bramnick pens op-ed critical of insurance pre-approval requirements

TRENTON, N.J. – In an op-ed in The Star-Ledger, Assembly Republican Leader Jon Bramnick wrote that insurance company clerks should not be making medical decisions.

“It is time we put patients first. It is time we remove the obstacles for patients who are ill and their medical doctors who studied for years to be able to knowledgeably prescribe treatment,” Bramnick said.

Why is some insurance clerk in charge of your health instead of your doctor? Lawmaker says that’s just wrong.

Jon Bramnick

By Jon Bramnick, Star-Ledger Guest Columnist

Doctors should be making medical decisions not insurance companies.

Historically, doctors would order tests or prescribe medicine and patients would take it as directed. Now, a myriad of bureaucratic obstacles required by insurance companies makes patients and doctors wait for approvals for necessary medical tests, procedures and medicine.

It puts insurance clerks, without any medical background, in charge of your treatment – not your doctor. And, it is a nightmare for patients. Up to 92 percent of doctors say the process significantly delays patients from getting treatment.

According to a 2018 American Medical Association survey of 1,000 doctors, 28 percent of physicians said that the prior authorization process had life-threatening consequences for their patients. Approximately 65 percent of physicians waited at least one business day for a decision and 26 percent said they waited for three or more. Three quarters of patients end up abandoning their treatment plans as a result of prior authorization requirements.

Even cancer patients are put on hold while an insurance company decides their fate. Radiation oncologists named prior authorization as the greatest challenge facing the field.

Doctors are reporting an increase in prior authorizations. They even exist for many generic medications that have been around for years.

If a prior authorization is denied, the appeal process can take up to thirty days. During this time, patients are unable to start treatment, which doctors believe affect clinical outcomes for 9 out of 10 patients.

While most claims are ultimately approved, it is not without recurring paperwork and multiple phone calls. This further supports the argument that these prior authorizations are unnecessary, burdensome and a waste of time.

It is not even clear whether insurance companies save money. A study that examined the records of more than 4,000 Type 2 diabetes patients, found that those who were denied medication that required prior authorization actually ended up having higher overall medical costs in the end. It is easy to assume that their medical issues worsened due to the fact they were unable to obtain the medication they needed to control their diabetes.

The pre-authorization paperwork can eat up approximately 15 hours

each week for a standard medical practice. Researchers estimate that the pre-authorization process wastes nearly $70,000 of a physician’s time every year on paperwork and phone calls instead of using that time to treat patients. Altogether, it’s estimated to waste at least $23 billion (and up to $31 billion) every year nationwide.

Most recently, certain insurance companies in New Jersey started to require pre-approval for both pregnancy and non-pregnancy related ultrasound testing. Ultrasounds are used to diagnose conditions like heart disease, and pancreatic, prostate and thyroid cancer, among others. A doctor orders an ultrasound if there is reason to believe a baby may have a problem with how their hips are developing. Most commonly, expectant mothers rely on ultrasounds to monitor their unborn baby’s health. Now, there may be a delay in care because insurance companies think they know better than a medical doctor.

Patients’ well-being should take precedence over the bottom line. A doctor’s prescription should be all the approval a patient needs.

I introduced a bipartisan bill last year, with Assemblyman Paul Moriarty, the Assembly Consumer Affairs committee chairman, which would ban mandated pre-approvals for tests, treatments and prescriptions normally covered by health insurance.

It is time we put patients first. It is time we remove the obstacles for patients who are ill and their medical doctors who studied for years to be able to knowledgeably prescribe treatment.

Insurance companies don’t deserve a place in the decision-making process. That should be left to the doctor and their patient.

Assemblyman Jon Bramnick is the Republican leader in the Assembly. Representing parts of Union, Somerset and Morris counties in New Jersey’s 21st District, he has served in the General Assembly since 2004.