Streamline treatment approval process

In these days of complicated medical care, seldom do you see a simple, common-sense solution to an obstacle for Iowans receiving easier access to medical care. For countless medical procedures and drug therapies, prior authorization by the insurance carrier (payer) is required before the treatment can begin.

Prior authorization is a tool used by insurance companies and third-party payment processors requiring doctors to obtain approval for certain procedures, treatments and drug therapies.

Although prior authorization is a valid tool to control the cost of expensive medications or treatments, the process has blurred into a monstrous maze of red tape designed to save money for the insurer, not improve the health of the patient. A doctor's years of experience and firsthand knowledge of the patient's medical condition are tossed aside in favor of often complicated and cumbersome bureaucratic processes.

In Iowa, insurers/payers use nearly 700 forms for the prior authorization process. Each doctor's office must manage all these forms and then choose the correct one to seek prior authorization. In order to provide the patient with fast, efficient and effective medical care, California and other states recently adopted a single form for doctors seeking prior authorization for treatments and/or medications. Some Iowa insurers have almost 200 forms, while others have one simple form. These mazes of forms and processes, not to mention an undefined time frame in which to approve or not approve requests, only delay a patient's ability to obtain the care they need.

Red tape should not dictate a patient's access to quality health care and the timely and needed treatments and drug therapies required to return them to good health.

The Iowa House of Representatives last month passed a bill sponsored by Rep. Linda Miller, R-Bettendorf, which clearly helps patients and doctors with the prior authorization process. It requires a response from the insurance carrier/payer within three days and creates one simple form for doctors to request prior authorization. Miller's solution is so solid and 'Iowa common sense” that the bill passed the House 99-0.

Community Health Charities of Iowa and its 31 health-related organizations - all serving and advocating for thousands of Iowans affected by one or several chronic diseases - support and endorse a streamlined and simplified prior authorization process. The lives and well-being of thousands of Iowans can be impacted positively by a simpler and streamlined process.

Iowa Senate leadership, Majority Leader Mike Gronstal and President Pam Jochum, need to hear from Iowans that they desire an easier-to-navigate prior authorization process when it comes to health care. On behalf of the countless Iowans who are impacted by the process, Community Health Charities of Iowa and its health-related organizations strongly encourage the Iowa Senate to take the lead of its Iowa House counterpart and pass this common sense solution to patient access.

l Jim Swanstrom is president and CEO of Community Health Charities of Iowa, based in Des Moines; www.healthcharities.org/Iowa. Comments: jswanstrom@healthcharities.org