Opinion: End dangerous delays to patient care

Bobby Mukkamala and Trudy Ender

It happens every day in Michigan.

A patient with a health challenge or illness walks in to see her physician. The physician examines the patient and then either diagnoses the problem and prescribes a treatment to address the issue, or orders the additional testing and screening needed to develop a diagnosis and a treatment plan. 

Then everything grinds to a halt. The waiting begins, and it persists. Meanwhile, the condition worsens, and the patient’s health deteriorates. 

Sometimes answers arrive days or weeks later.  Sometimes they don’t.   

It’s a health care crisis created by health insurance companies’ misuse of prior authorization and step therapy red tape and bureaucracy to delay — and sometimes flat out deny — patients access to the treatment and medicine they have been prescribed — treatment and medicine their physicians know they need.

Thankfully, we have an opportunity to do something about this crisis. 

Lawmakers in Lansing have introduced legislation that would bring new transparency, fairness and clinical validity requirements to the prior authorization and step therapy processes insurers use to bog down patient care, ensuring patients throughout the state receive timely coverage decisions, and the care they need.  

Insurance companies' misuse of prior authorization has added to a health care crisis which Senate Bill 612 aims to fix, say Mukkamala and Ender.

This common-sense reform that puts Michigan patients first is supported by an overwhelming number of patients, patient support organizations, physicians and health care providers. The numbers show why:

Ninety-four percent of Michigan physicians report that prior-authorization red tape cause delays in care for patients. Those delays are much more than an inconvenience — they’re costing patients their health, quality of life, and sometimes even their lives.

In a recent survey from the American Medical Association, 28% of physicians reported that prior authorization has resulted in a serious adverse event including hospitalization, permanent disability and even death. In that same survey, 75% reported that prior authorization can lead to treatment abandonment, resulting in worsening conditions and deteriorating health for patients.

And it's all for nothing.

More than 97% of all first-time prior authorization requests are eventually approved. In other words, insurers are delaying access to care and jeopardizing the health of patients for no reason. 

Senate Bill 612 would help rein in these devastating practices. Among other things, the legislation would require insurance companies publish their prior authorization requirements on their website somewhere easy to find and written in easily understandable language. Bringing the process out of the shadows will save physicians, providers, and most importantly, patients, precious time when it comes to administering and receiving critical care.   

Additionally, the legislation empowers physicians to override insurers’ dangerous step therapy protocols when they consider it to not be in the patient’s best interest, ensuring patients — and not insurance company bureaucrats — have the final say when it comes to health of Michigan’s patients. 

And most importantly, it puts an end to the waiting. Senate Bill 612 mandates that urgent and non-urgent prior authorization decisions must be made in 24 and 48 hours, respectively, ensuring Michigan patients receive the care they need when they need it. 

Because the fact is, for many patients across the state, health really can’t wait.

Everyday, patients across Michigan continue their battles with illness and disease, including life-threatening conditions like cancer. More than 1.3 million people are diagnosed with just breast cancer alone every year. That’s a staggering figure, made more sobering by the fact that many of those individuals will face significant hurdles in receiving the care and treatment they need to win their battle with cancer — insurance companies dragging their feet should not be one of them. For these women and men, every day — every hour — matters. 

Patients deserve better from our health care system. We encourage lawmakers in Lansing to deliver by supporting Senate Bill 612.

Bobby Mukkamala is president elect of Michigan State Medical Society. Trudy Ender is executive director of the Susan G. Komen Foundation of Michigan.