On October 22, William E. Bennett Jr., a gastroenterologist based in Indiana, authored an opinion piece about prior authorization that was published by Houma Today. This article explains the process that is required to obtain a prior authorization approval from an insurance company and how long the process typically takes. Dr. Bennett also explains how “peer-to-peer” appeals work, by having the prescribing physician consult with a clinician that is employed by the insurer. The two clinicians share a conversation about the patient and the insurer’s clinician will either approve the medication being prescribed or deny the appeal. While this type of appeal is advertised as a way to ensure that the patient is receiving the right medication, but Dr. Bennett claims that his “peer-to-peer” appeals are rarely denied and that the process exists only to save the insurance company by creating another hurdle that clinicians and patients must overcome to deliver care to the patient. Furthermore, Dr. Bennett claims that the insurer’s clinician is unqualified to make a medical assessment of the patient because they have not examined the patient and they do not have a relationship with the patient or their family. He feels that this amounts to the practice of medicine, which insurers should not be engaged in.
Dr. Bennett emphasizes that, as a clinician, the process can be navigated with some degree of certainty, but as a patient, the barriers to care can seem insurmountable. He points out that many patients do not pursue the appeals process after they receive a coverage denial, and that this has a greater impact on vulnerable populations, such as minorities and cancer patients. In closing, Dr. Bennett asserts that it is time to remove insurers from the medical decision-making process by prohibiting them from engaging in the practice of medicine.