Radiologists ask commercial payers to pause prior authorization as specialty works through ‘enormous’ imaging backlog
Radiologists are asking commercial insurers to suspend prior authorization policies for at least three months as the specialty works through a backlog of exams built up since March.
The American College of Radiology shared Thursday that its member physicians are “concerned” about such impediments to resuming routine care. As such, the college has shipped letters to the country’s five largest commercial health insurers, asking for relief.
ACR members estimate it could take at least four weeks to work through the backlog of nonurgent imaging in some modalities, and as long as 27 weeks in others. Radiologists are looking for a temporary suspension of these provisions, which require docs to check first whether an insurer covers an imaging exam, often leading to extra paperwork and delays in care.
“Prior authorization is a major barrier for primary care physicians and various specialists,” CEO William Thorwarth Jr., MD, wrote in a April 28 letter to the head of United Healthcare. Similar transmissions also went to leaders at Aetna, Cigna, Anthem and the Health Care Service Corp.
“A moratorium on prior authorization would significantly help radiology practices and their referring providers best serve their patients and assist in ensuring an efficient recovery effort on the enormous backlog of imaging exams that have accumulated since early March and for some time to come,” he added later.
ACR is requesting that payers initiate this mortarium as soon as the public health emergency ends, and extend it for three months beyond that date. Practices have been forced to lay off and furlough employees to respond to volume slowdowns, and many may not have staff in place to comply with these policies, the college noted.
After pressure from numerous provider groups, the federal government is also urging Medicare Advantage plans to forgo prior authorization requirements during the COVID-19 pandemic.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.