AHA report calls for national relief from burdensome health plan practices

Commercial health plans are using prior authorization and payment delays and denials to make it more difficult for some Americans to access the care they need, creating an extensive approval process that wastes billions of dollars and contributes to clinician burnout, according to a report released today by the AHA.

While the findings pre-date the COVID-19 public health emergency, the report underscores the urgency to address these concerns as hospitals care for COVID-19 patients.

“Hospitals and health systems face severe staffing shortages during the COVID-19 pandemic. We cannot afford commercial health plan abuses that deny medically necessary treatment to patients and increase clinician burnout on top of that,” said AHA President and CEO Rick Pollack. “Caregivers need immediate relief from these excessive burdens so they can focus their attention where it is needed most: caring for patients and saving lives.”

The report offers national policy solutions, including standardized prior authorization requirements and processes, and increased oversight of health plans to stop inappropriate payment delays and denials.