05.14.20

AAO Calls on Health Plans to Suspend Prior Authorization and Step Therapy

Source: American Academy of Ophthalmology

The American Academy of Ophthalmology this week published an open letter to all health plans, calling for the suspension of regulatory barriers, specifically prior authorization and step therapy, for both COVID-19 and non-COVID-19-related services until the health care delivery system returns to normalcy. 

The Academy is not alone in calling on all health plans to remove these regulatory barriers. It is leading a coalition (Regulatory Relief Coalition) of a dozen national physician specialty organizations advocating for patients.

“Even under normal conditions, prior authorization and step therapy requirements delay and disrupt the sight-saving care ophthalmologists provide their patients,” according to an AAO statement. “In a pandemic, these policies have reached levels of comic absurdity as there’s no one to pick up the phone when physicians call seeking treatment approval because the insurance company shuttered its office due to the pandemic. Or, when practices, operating with skeleton staffs, have no one available to remain on hold with a carrier for up to four hours to obtain approval.”

This is not just a bureaucratic nuisance; real people are suffering real health consequences from treatment delays, according to the AAO.

“It’s happening across the country and across all medical specialties: People who need treatment to save their sight; people who need urgent spinal surgery to prevent irreversible damage; people with rheumatoid arthritis unable to walk due to swollen joints, heart patients with new chest pain who need a stress test provided in physicians’ offices; all of them, waiting for an insurance carrier to approve a treatment their physician prescribed,” the AAO stated.

“As we emerge from the pandemic and physicians resume routine office visits and elective surgeries, they will face the challenge of providing long-delayed, medically necessary services to patients whose health care needs were postponed during the crisis. Prior authorization burdens will only further delay this care.”

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