News & Media
MSMS Op-Ed: Prior Authorization Hurts Michigan Patients and Providers—The House Must Help Fix That
While most pregnancies follow a routine course, a significant number of women experience complications that put their lives—and the lives of their unborn children—at risk, transforming what would have previously been viewed as a beautiful and completely normal part of everyday life into a high-risk situation that often requires complex and immediate care. In these moments, the doctor-patient relationship needs to be paramount, because quick decision-making and decisive action really can be the difference between life and death.
Unfortunately, that isn’t always the case here in Michigan. Far too often, insurance companies use the cost-control process known as prior authorization to delay and sometimes even deny patients from accessing the diagnostic services, treatments, and medicines their physicians have prescribed.
It’s a problem I see and deal with all the time. Pregnant women with diabetes—not an uncommon condition—are a great example. Blood sugar that is not well controlled in a pregnant women can lead to dangerous and severe complications for both a mother and her baby. It’s a serious concern and one that needs to be monitored closely. It isn’t unheard of for a pregnant woman with diabetes to need to check her blood sugar levels up to 10 times in a single day to ensure it is staying properly balanced. The problem is insurance companies often use prior authorization to delay orders for the equipment these women need to monitor and manage their diabetes, putting the lives of these women and their fetuses at risk in the process.
It’s not just diabetes. And it’s not just pregnant women. Every day, prior authorization delays jeopardize the health and safety of countless patients throughout the state, each struggling more than they must in the fight to manage their own unique conditions and ailments and the suffering and anxiety that come along with them.
What makes it even more frustrating is the fact that 97.5 percent of all first-time prior authorization requests are eventually approved. In other words, insurers are delaying patients’ access to care for essentially no reason and taking away precious staff time that could be better spent providing patient care in the process. A shortage of health care workers has impacted physician practices for several years and COVID-19 has only exacerbated the staff shortage. That’s something we can ill afford, especially during a pandemic.
Thankfully, there’s meaningful reform on horizon that would dramatically improve the prior authorization process. Senate Bill 247 goes a long way towards reducing the red tape patients and providers are forced to navigate, by reforming the prior authorization process to ensure that it is transparent, timely and that the doctor-patient relationship ultimately takes precedence over insurance company paperwork. It would be a monumental win for patients and providers alike, and I’m excited to say that it’s a reality that isn’t that far away.
This past spring, the Michigan Senate unanimously passed SB 247, bringing Michigan’s patients and providers one step closer to this potentially life-changing reform. The onus is now on the House to follow suit.
And I do mean life changing. The sobering reality is every year, more patients than I would ever care to count face medical circumstances where they really can’t afford to wait. Every day, new patients start new battles with life-threatening conditions like cancer. Every day—sometimes every hour—matters in these fights.
Michigan’s lawmakers now have a real opportunity to make sure more patients come out on the winning end of those fights, and it starts with getting SB 247 over the finish line.
Nita Kulkarni, MD, is board certified in Obstetrician & Gynecologist practicing in Genesee County, sits on the MSMS Board of Directors and is Chair of the MSMS Committee on State Legislation and Regulations.