The focus of the Obama administration was always on increasing raw insurance coverage for its citizens. That is, on measuring so-called “covered lives.” But the deeper focus needs to be on whether these “covered” individuals are actually able to receive the care they need.
Pre-authorization or prior authorization is a tool insurance companies use to limit the amount of services they provide for their customers. In essence, it’s a simple way to reduce costs by delaying or not approving planned, non-emergency (elective) surgery for patients who need it. As the ACA made insurance company profit margins tighter, the companies turned to other profit-making strategies. This is frustrating to patients, costly to doctors, and violates the patient-physician relationship.