Physicians and medical students at the American Medical Association (AMA) Interim Meeting of the House of Delegates have voted to adopt a policy addressing issues with insurers' prior authorization processes. The policy asserts that once a health plan has reviewed and approved the medical necessity of treatment, this authorization should guarantee payment.
"Prior authorization should be sufficient to guarantee payment," stated AMA Board Member Marilyn J. Heine, M.D. She emphasized that it is unacceptable for health plans to approve necessary care but then create barriers to payment, which she described as an affront to physicians, patients, and employers.
The new policy aims to protect patient-centered care by supporting a federal ban on inappropriate denial of payments for pre-certified medically necessary care. Additionally, the AMA will encourage legal action against insurers engaging in post-service payment denials and recoupment.
This decision by the 700-member House of Delegates builds on existing AMA policies opposing prior authorization practices that conflict with clinical guidelines, waste resources, jeopardize quality care, and harm patients. The AMA continues its collaboration with federal and state officials to reform these systems and reduce obstacles to necessary medical care.
The AMA's FixPriorAuth.org campaign has led to significant progress in 2024. This includes final regulations from the Centers for Medicare & Medicaid Services aimed at reducing patient care delays through streamlined electronic processes for physicians. Lawmakers have also introduced an updated bipartisan version of the Improving Seniors’ Timely Access to Care Act in both chambers of Congress. Furthermore, over a dozen states have enacted laws supported by the AMA that aim to minimize delays caused by prior authorization requirements.
The AMA remains committed to reforming prior authorization programs so that physicians can prioritize patient care over administrative tasks.
