As Illinois healthcare professionals work to control the spread of coronavirus, Blue Cross Blue Shield of Illinois thankfully announced it will cover tests and treatment for those showing symptoms. This welcome news underscores how health plans can work to ensure timely access to care — even during the most serious public health emergencies — and prevent cost considerations from becoming a serious roadblock for patients.
Even for those who have health insurance, paying for health care testing and treatment can often be cause for concern. Policies such as prior authorization, which requires health care providers to receive approval from an insurer before prescribing a treatment or service, have become widely integrated among health insurance plans and can end up delaying treatment and undermining what practitioners deem to be the most effective course of care.
Providers have long complained prior authorization requests can take a frustratingly long time to be approved — or worse yet, denied. In fact, a 2018 survey found more than one in four physicians reported that these roadblocks “led to a serious adverse event” for patients — especially dangerous during a public health emergency such as the coronavirus outbreak.
Illinois lawmakers took action to strengthen patient protections, passing a pair of bills in 2017 that would increase efficiency with prior authorization requests. For example, under the laws, health insurers were required to respond to prior authorization requests in 72 hours for routine care and 24 for urgent situations.
But many providers say that health insurers are not abiding by these new requirements. According to a recent survey, for example, just 33% of Illinois providers say that health plans are meeting these approval request times “every time” for emergency situations.
While health plans are still adjusting to these new regulations, there is clearly room for improvement when it comes to increasing access to care. Physicians and patients should go through the appeals process and file complaints to petition insurers for their treatments, while lawmakers and regulatory agencies can take a more proactive approach to ensuring that these policies are being enforced appropriately.
Blue Cross Blue Shield made the correct decision to prevent prior authorization requests from getting in the way of practitioners helping patients with coronavirus in Illinois. Now, health plans throughout the state should follow this lead by holding themselves accountable to state laws and always ensuring timely access to treatment and care for patients.
Stacey Worthy is counsel to Aimed Alliance, a non-profit health policy organization that seeks to protect and enhance the rights of health care consumers and providers.