PAF, a patient advocacy organization dedicated to helping patients with cancer and other serious health conditions, studied the use of preauthorization programs for medical imaging services between 2007 and 2011. During this period, 4,360 patients contacted PAF regarding insurance denials for imaging procedures.
PAF's internal case management data showed a doubling over the past four years of insurance coverage denials to patients seeking imaging services, according to AMIC. Ninety percent of these denials were actually covered by those health plans, and 81% of the insurance denials for imaging procedures were due to prior authorization programs, AMIC said.
On average, PAF's professional case managers required 15.4 contacts (phone calls, letters, or emails) per patient case to determine why the imaging test was being denied coverage, AMIC said.
Instead of mitigating utilization, policymakers should seek evidence-based, physician-developed appropriateness criteria to guide the proper use of imaging services and to ensure patient access to the right scan at the right time, Tim Trysla, AMIC's executive director, said in a statement.
There has been no scientific, peer-reviewed research on the safety, efficacy, or impact on administrative costs of radiology benefits managers (RBMs), AMIC also noted. With recent independent reports confirming a decline in medical imaging utilization rates, AMIC warned that prior authorization will only further hinder access to diagnostic imaging services.