Key Takeaways
- A large majority of the public (73%) think that delays and denials of services and treatments by health insurance companies are a major problem. Majorities across demographic groups agree that denials and delays of care are a major problem, with at least two-thirds across income groups and majorities across partisanship. Six in ten (57%) Republicans, eight in ten (79%) independents, and over eight in ten (84%) Democrats consider delays and denials of services by health insurance companies to be a major problem.
- In June, a group of health insurance companies, along with Secretary of Health and Human Services Robert F. Kennedy, Jr. and Administrator of the Centers for Medicare & Medicaid Services Dr. Mehmet Oz, announced a voluntary initiative to reduce the burden of prior authorizations for patients, but few people have heard of the initiative to reduce the burden of prior authorizations. Just two in ten (20%) adults say they’ve heard “a lot” or “some” about this new initiative. In addition, few people think it’s likely that health insurance companies will follow through on this pledge, with six in ten adults saying it is “not too likely” or “not at all likely” that health insurance companies will follow through on the voluntary initiative in a way that makes a difference for patients.
- The process of getting prior authorizations feels burdensome for many. Among the half (51%) of insured adults who say they have had to get a prior authorization in the past 2 years, many report difficulty navigating the process. Almost half (47%) of those who were required to get a prior authorization in the past two years say it was “somewhat difficult” (34%) or “very difficult” (13%) to navigate the process of getting prior approval for a health care service, treatment, or needed medication.
Prior Authorizations
Recently, Secretary of Health and Human Services Robert F. Kennedy Jr. and Administrator of the Centers for Medicare & Medicaid Services Dr. Mehmet Oz joined with insurance companies to announce a new voluntary initiative in which dozens of health insurance companies pledged to reduce the burden of prior authorizations. The pledge included promises from health insurance companies to require prior authorization less often, speed up the review process, and use clear language when communicating with patients.
The pledge addresses an issue that most of the public views as a problem. Three-quarters (73%) of adults say that delays and denials of health care services by health insurance companies are “a major problem,” with another two in ten (21%) who say it’s “a minor problem.” Few adults (6%) don’t think delays or denials are a problem. Majorities across partisans agree, including large majorities of Democrats (84%) and independents (79%) and over half of Republicans (57%) saying delays or denials of care by insurance companies are a major problem.
In fact, agreement spans many demographic groups, with at least two-thirds across income groups and insurance type saying delays and denials of care by insurance providers are a major problem.
Very few adults have heard of the newly announced initiative to reduce the burden of prior authorizations, with two in ten saying they’ve heard “a lot” or “some” about it. Another quarter (23%) have heard “a little,” while more than half (56%) have heard “nothing at all” about the pledge.
Adults under age 65 who purchase their own insurance are more likely to say they have heard about the initiative, with a third (35%) saying so compared to one in seven (14%) of those who have employer-sponsored insurance. About two in ten of adults under age 65 with Medicaid (23%) and those ages 65 and older with Medicare (22%) say they’ve heard “a lot” or “some.”
Few people think it’s likely that health insurance companies will follow through on this pledge in a meaningful way. Six in ten adults say it is “not too likely” or “not at all likely” that health insurance companies will follow through on the voluntary initiative in a way that makes a difference for patients. Republicans are more likely than Democrats or independents to believe insurance companies will follow through, though still a very small share (9%) think it’s “very likely”, while about half (47%) think it’s “somewhat likely.” Two-thirds (67%) of independents and seven in ten (71%) Democrats think it is not likely insurance companies will follow through in a meaningful way.
Experiences with Prior Authorizations
One reason why most adults may see prior authorization as a problem may be because many people have had to deal with them and found them difficult to navigate.
Half (51%) of insured adults say that in the past two years, their health insurance company has required them or their health care provider to get prior authorization before they could receive a health care service, treatment, or medication that they needed.
There are no significant differences by insurance type in the share who report needing prior authorization, with about half across types of insurance saying they were required to get approval before they could get a service, treatment, or medication in the past two years. While traditional Medicare typically does not require prior authorizations for most services and medications, Medicare Advantage does require prior authorizations for enrollees seeking certain services.
Among those who face prior authorization, many report difficulty navigating the process. Almost half (47%) of those who experienced a need for prior authorization in the past two years say it was “somewhat difficult” (34%) or “very difficult” (13%) to navigate the process of getting prior approval for a health care service, treatment, or needed medication.
Many people also report experiencing delays or denials of services when they are subject to prior insurance authorization. Among all of those who reported needing prior authorization in the past two years, about half say their health insurance company has delayed their ability to get (48%, 24% of all insured adults) or denied coverage (43%, 22% of all insured adults) for a service, treatment, or medication that their doctor requested. Among all insured adults, three in ten (29%) say their health insurance company has delayed or denied their ability to get a service, treatment, or medication that they or their doctor requested in the past two years. These shares are similar across insurance types.
While administrative data provides a lower instance of delays or denials in care than what individuals self-report in the latest KFF Tracking Poll, possibly due to misreporting or initial denial that was eventually approved, it is clear that many people feel like the process has delayed their care.
Some services are more often subject to prior authorization, including surgery, hospitalization, imaging services, specialty drugs, specialty medical equipment, care from a specialist, specialized lab testing, and mental health services. These individuals (69% of insured adults) report higher rates of prior authorization, delays, and denials of care.
Six in ten (62%) insured adults who say they needed at least one of these types of specialized care report that they were required to get prior authorization for a service, treatment, or medication in the past two years. More than half of this group (58%, 36% of all insured adults who needed specialized care) say their insurance delayed or denied their treatment, including 30% who experienced a delay, and 27% who experienced a denial.
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