Mental Health Providers Say Prior Authorization Hinders Consumer Access to Care

By Consumers for Quality Care, on January 4, 2023

At a recent subcommittee of the U.S. Senate Committee on Health, Education, Labor and Pension (HELP) hearing, several mental health providers testified that prior authorization requests are hampering patient care, according to Fierce Healthcare.

Providers complained that prior authorization, a cost management tool used by insurers that requires approval before physicians can administer certain services, comes with long wait times and high administrative costs.

“It is mind-numbing,” said Ashley Weiss, Director of Medical Student Education in Psychiatry for Tulane University and one of the panel’s witnesses. “It will take weeks sometimes getting prior authorization for community-based mental health services.”

Particular concerns of providers include getting responses for Medicaid mental health claims and the burdensome wait time for approval. “The wait times for getting into mental healthcare… for families can be really impossible to navigate,” said Sharon Hoover of the National Center for School Mental Health.

CQC urges lawmakers and regulators to reform burdensome prior authorization requirements for consumers.