Apollo Healthcare is keeping an eye on recent prior authorization trends in the healthcare industry due to the COVID-19 Pandemic. Most recently, Georgia’s Insurance and Safety Fire Commissioner, John F. King, issued a directive to suspend all prior authorizations for surgeries, admissions, inpatient hospital services, and as post-acute admissions. This deviation begs the question, how crucial is acquiring a prior-authorization, and more specifically, how crucial is prior authorization in the Oncology setting?
This isn’t the first announcement we’ve seen like this. United Healthcare and Anthem made announcements recently about reduced administrative burdens for physicians and facilities. Many payers are starting to eliminate these requirements altogether across the United States. Unfortunately, from our experience, this exemption is likely to end in claim denials, leaving your practice with the cumbersome task of appealing the payers payment decision. Some would call this scenario surprise bill roulette, and the odds are never in the patient or providers favor.
We believe prior authorization is even more important in the Oncology space, since most of our services tend to cost more to deliver and are used in combination with other high cost therapies throughout the patient’s journey.
We believe suspensions for prior authorizations in hospital settings are likely to expand and affect many more states across the country in the coming days. This means oncology related admissions and surgeries may be exempt. With that said, we believe the potential for impact in the outpatient oncology setting, particularly in free standing facilities is low.
With new announcements happening daily, we want to emphasize the importance of obtaining prior authorization when possible. We know the administrative burden this can have on your clinical team and have developed a model that can relieve you and your practice of this administrative nightmare for good. The Apollo team is comprised of board-certified clinicians that are trained in insurance authorization. Not only can our team get you that important authorization, but we can do it fast and with extreme efficacy. We believe that solidifying a “clean” prior authorization is the key to avoiding any mishaps when it comes time for reimbursement.
Apollo Healthcare will be keeping track of all COVID-19 related prior authorization trends in the coming weeks. We will provide updates as soon as they come in, especially if there is any effect on the Oncology industry. Finally, we are cautiously optimistic that payers will face this time with fortitude, and not use this as another “loophole” to avoid reimbursement.
