What Doctors Wish Patients Knew About Prior Authorization

Prior Authorization

What doctors wish patients knew about prior authorization | American Medical Association (ama-assn.org)

The American Medical Association (AMA) has a very useful series called “What Doctors Wish Patients Knew”. You can subscribe here: What Doctors Wish Patients Knew™. It doesn’t have any articles specific to wound care (although I bet if we contacted the AMA, they might be willing to create content like that!), but there are several that are very useful in a general way. This one is about the prior authorization process (PA) used by private payers and thus, by Medicare Advantage plans.

The article explains why it exists, how payers use it to limit payment, how time consuming it is for physicians and how it affects what treatments a physician can provide. It also provides a link that patients and physicians can use to express their experience with the PA process. I confess that I often have thrown up my hands and not even bothered to try to fight the PA process on behalf of a patient, using the excuse that since there were only 24 hours in the day, I should pick the battles that I could actually win and PA wasn’t one of them. Shame on me. Maybe if I’d let patients read this article on the PA process, I could have discussed the issue with my patients honestly, rather than just running away from it.


Caroline Fife, MD

Dr. Fife is Co-Founder and Chief Medical Officer of Intellicure, Executive Director of the US Wound Registry, and Editor of Today’s Wound Clinic.

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