BlueCross BlueShield of WNY drops preapproval on some services

BlueCross BlueShield of Western New York today announced it will lift the prior authorization requirement for 212 services, meaning doctors and patients will no longer need the insurer's approval in those cases.

The news will please many physicians who often complain that prior authorization policies, put in place to reduce unnecessary care and control health care costs, can be a time-consuming headache that complicate medical decisions.

The change is consistent with a call last month by 17 health care organizations, including the American Medical Association, for reform of prior authorization requirements imposed by health plans for medical tests, procedures, devices and drugs. About 75 percent of 1,000 doctors surveyed by the AMA responded that preauthorization for services constituted a "high" or "extremely high" burden to their practices.

Preauthorization is the process used by health insurance companies to determine if a prescribed procedure, service or medication is medically necessary and covered under a member’s benefits. BlueCross BlueShield said only 3 percent of all its medical claims in 2016 were subjected to prior authorization.

Read more: http://buffalonews.com/2017/02/01/insurer-policy-shift-drops-preapproval-requirement-many-services/