DES MOINES, Iowa — What the Trump administration is calling a breakthrough in health insurance reform could streamline the process for patients to get care approved by insurance companies and free physicians up from paperwork.

Major U.S. insurers have voluntarily agreed to speed up and reduce prior authorizations, an often lengthy process that happens when doctors request approval from insurance companies before providing care.

Dr. Wendy Woods, the Chief Medical Officer for UnityPoint Health says, as a pediatric oncologist, roughly 60% of medications and 100% of imaging she requests require prior authorization.

Insurers state that prior authorization helps ensure patients are getting medically necessary care and allows them to control costs, but providers and patients say the process only leads to care delays, or in some cases, denials.

Woods says as a provider, prior authorization is a process she spends a significant amount of time on weekly.

“On average, a single authorization can take up to an hour of a physician’s time. A couple of weeks ago, I spent three hours on a phone loop with an insurance company being told that’s not medical, that’s pharmacy [and vice versa], and never even getting to talk to someone to do my appeal. And ultimately, [we] did not get the problem resolved after spending three hours on a single patient. So, I mean it could range from five to 10 hours in a weeks time, depending on the volume of patients you’re seeing.”

Woods said when delays do happen, “The only person that we are impacting in all of this is the patient. They’re not getting the care that they need in the time that they need it. So we’re publishing articles and collectively doing research. We’re using every method that doctors know to raise awareness of this. Our patients end up frustrated. Unfortunately, the patients oftentimes don’t realize that this is not the physician’s office or the physician that is the barrier. The barrier is the care delivery and the approval process from the insurance company.”

Woods says providers are “eager for reform, but are not holding their breath.”

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