Kentucky Physicians to Convene in Frankfort to Advocate for Prior Authorization Reform
FRANKFORT– Physicians from across the state will convene in Frankfort on Wednesday, Feb. 21 to advocate for prior authorization reform as part of the 2024 Kentucky Medical Association’s (KMA) Physicians’ Day at the Capitol.
The annual event brings together physicians from every specialty and area of the state to advocate for the advancement of healthcare in the Commonwealth. This year, KMA physicians are particularly united around communicating the importance of reform to the prior authorization process.
“The current prior authorization process leads to delays for patients, administrative burdens for physicians, and increased costs,” said KMA President Michael Kuduk, M.D. “It’s time for us to pass a common-sense solution that doesn’t harm our patients or overburden our healthcare system.”
The KMA-supported solution is House Bill 317. Sponsored by Rep. Kim Moser and Rep. Robert Duvall, HB 317 would automatically waive prior authorization requirements if a physician has a 90 percent approval history for a specific procedure or service. It has been assigned to the House Banking and Insurance Committee, where it joins the insurer-backed House Bill 318. HB 318 would also require insurers to establish a “gold carding” program; however, insurers would have the ability to set up programs on their terms, which would require participating providers to enter into an electronic medical records access agreement as well as a value-based healthcare reimbursement agreement where the provider assumes downside risk.
“The bottom line is that House Bill 317 works in favor of patients and physicians, whereas House Bill 318 continues to benefit insurance companies and put up additional roadblocks to care. It’s imperative that the legislature understand the differences between these two bills and that we voice our support for HB 317,” said Dr. Kuduk.
“KMA’s Physicians’ Day at the Capitol allows physicians to engage directly with state legislators and policymakers on some of the most important issues impacting healthcare delivery, access, and quality in Kentucky. We look forward to seeing our physician colleagues and elected officials and are excited for the opportunity to gather together and advocate on behalf of our patients across the state,” said Dr. Kuduk.
WHO: Kentucky Medical Association
WHAT: 2024 Physicians’ Day at the Capitol
WHEN: Wednesday, Feb. 21, 2024
WHERE: Kentucky State Capitol Annex, Room 131
# # #
The Kentucky Medical Association is a non-profit 501(c)(6) organization that supports physician members and their patients with a variety of services. The KMA, established in 1851, represents and supports nearly 7,000 physicians, physician residents, and medical students across the Commonwealth of Kentucky. Learn more about the KMA and its programs at www.kyma.org.
From the patient’s perspective, I am told that I am responsible for making sure that the prior authorization is in place. BUT, I am not given the tools to ensure or initiate that process. I am at the mercy of the doctor’s lowest paid help to make sure that the prior authorization is in place prior to the medical procedure.
I have my insurance company’s intake number. However, I do not have access to the doctor’s National Provider’s Identifier (NPI). Neither do I have the specific procedure’s code number. There may be other codes necessary that I do not have access to. Therefore, I cannot start the process.
It would be helpful and give me peace of mind if I could alert the insurance company that I may need a prior authorization for my specific medical procedure.
There is a list of codes that the insurance company has that no longer require prior authoriztion. BUT, the list is not prominent and one must scurry down through muliple documents to find it or to know that it exists.
If I am going to be responsible for something, I want the tools to make sure that it will happen. Apparently to make life more exciting and suspenseful, the insurance company and doctor’s office wait until two days or so before the procedure to give and accept the request for prior authorization. The process for the doctor’s office is automated and can be filled in electronically. If the medical procedure no longer requires a prior authorization, the patient is not notified and wastes time and effort by hounding the doctor’s office for the prior authorization which is not necessary.
With the billing of one year’s medical procedures over $100,000.00, which was reduced to the insurance company paying about $19,000.00 and myself paying about $1,900.00 out of pocket, it should be obvious that I do not want to be bankrupted because I did not get the prior authorization.