Data highlights questionable value of preapproval process
The Washington state Office of the Insurance Commissioner recently released its annual Health Plan Prior-Authorization Data report, pursuant to WSMA’s successful advocacy in passing Senate Bill 6404 during the 2020 legislative session.
The OIC's 2021 report found that there were numerous codes that were approved 100% of the time. In fact, of the 469 distinct codes reported by carriers, 352, or 75% of the codes, were approved 100% of the time. Widely used codes for colonoscopies and psychotherapy were approved 99% of the time. All of which begs the question of what value prior authorization provides in those contexts.
The report also showed that mental health and substance use disorder (MH-SUD) code requests faired poorer against medical surgical code requests (Med-Surg). Carriers reported a lower number of requests, approval rates, and response times for MH-SUD-related codes. Response times averaged around 174 hours for both inpatient and outpatient MH-SUD, compared to an average of 118 hours for inpatient and outpatient Med-Surg codes.