Takeaway
Holistically caring for patients includes helping them navigate healthcare systems. Take time to support already stressed patients through the frustrating and opaque processes of insurance and prior authorizations.
Lifelong Learning in Clinical Excellence | January 9, 2025 | 2 min read
By Katharine Russo, PharmD, Johns Hopkins Medicine
It would be an unusual week if a few prior authorizations (PAs) didn’t come across my desk for completion or I didn’t receive questions from providers regarding denials, how we can appeal, or inquire what other options their patient has.
From a patient perspective and my own firsthand experience, PAs can feel like you’ve almost crossed the finish line, only to have the race called off at the last moment. Your clinician has told you this medicine will help your condition, they provide medication counseling, you ask them questions about it, and you’re excited for your condition to become better controlled. Only to be told a week or two later (after anxiously waiting) that your insurance said you can’t have it. Talk about a letdown.
From the provider perspective, you want your patient to get better, you’ve read the research for this medicine and know its benefit, you spend time counseling your patient and writing your note so the prior authorization can be completed, and are then back exactly where you started when the denial comes through. A frustrating process and never-ending paperwork and red tape.
Clinicians in all specialties can play a significant role in supporting patients struggling with PAs by showing empathy and providing practical assistance. Here are several ways clinicians can help alleviate the stress and confusion that often accompany the PA process:
1. Acknowledge the stress.
Clinicians can validate the patient’s (and their own) frustration by acknowledging the difficulty of the PA process. Acknowledge the emotional toll that waiting for approval can take.
2. Highlight the “why.”
Offer a clear explanation of what the PA process entails and why some medicines require approval.
3. Share what to expect.
Let patients know what to expect regarding timelines, potential roadblocks, and what follow-up will be needed. In the event the medication is denied, tell patients ahead of time there are other treatments that can be considered.
4. Provide detailed documentation.
Ensure all notes and diagnostic results are clear, thorough, and well-organized to help speed up the PA process. Consider adopting SmartPhrases for medications that require PAs frequently to improve efficiency and completeness of all required documentation.
5. Be proactive and collaborative.
Ensure you have an efficient office process for handling PAs.
6. Provide tools for self-advocacy.
Empower patients by teaching them how to follow up with insurance companies or request updates on the status of their PAs.
Empathy in healthcare isn’t just about providing clinical care; it also involves supporting patients through the often-frustrating processes of insurance and prior authorization. By providing understanding, transparency, advocacy, and practical help, clinicians can make a significant difference in alleviating the stress and hardship that many patients face in getting timely access to the care they need.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.