New reforms would reduce medical care delays

New legislation has been filed that would change a healthcare process that currently leaves many Illinois residents waiting for medical treatment because of insurance coverage requirements.

Illinois patients often have medical care delayed or denied because of their health plans’ use of a process called prior authorization.  Senate Bill 3822, also known as the Prior Authorization Reform Act, is a bipartisan solution that supporters say will bring much-needed transparency and streamlining to prior authorization requirements.

Health insurance companies and pharmacy benefit managers use prior authorization to cut costs, requiring health professionals to do extra paperwork before their recommended patient care is approved. Even when authorization is granted, too often insurance companies later deny payment for medical care they approved.

Prior authorization requirements are often not based on clinically valid criteria, and are administered by individuals who lack relevant qualifications. The Prior Authorization Reform Act would make sure prior authorization requirements are based on medical evidence and administered by qualified individuals.

Senate Bill 3822 has been introduced in the Senate and awaits assignment to a legislative committee where it will receive a public hearing.

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