People View Prior Authorization as Greatest Burden in Navigating the Health System

New  Kaiser Family Foundation (KFF) polling explores the challenges beyond costs that people with insurance face in navigating the health care system. People cite prior authorization review as their top problem by a wide margin, with a third (32%) saying prior authorization requirements are a “major burden.”

That’s more than say the same about understanding their bill or what they owe (23% say it is a major burden), getting appointments when they need them (20%), or finding providers who accept their insurance (17%).

When asked to choose which of those four factors is “the single biggest burden,” prior authorization before accessing certain tests, treatments, or medication ranks at the top (34%). Among people with a chronic condition that requires ongoing medical treatment (about half of all insured adults), 4 in 10 (39%) say prior authorization is the single biggest burden when it comes to getting care, more than twice the share who say the same about other obstacles.

“The complexity of the health system drives patients crazy, can have real consequences, and disproportionately affects people who are sick,” KFF President and CEO Drew Altman said. “Prior authorization review is the poster child for that complexity.”  Click here to learn more.

Awareness and Understanding of the Medicare Three (3) Day Rule
The Medicare 3-Day Rule requires a patient to have a medically necessary 3-consecutive-day inpatient hospital stay (counting) the admission day but not the the discharge day) before Medicare will cover a stay in a Skilled Nursing Facility (SNF). This rule ensures proper coordination for post-hospital skilled care, though waivers exist for some Medicare Advantage plans, Accountable Care Organizations (ACOs), and certain demonstration projects, potentially allowing SNF admission without the prior 3-day hospital stay. 

Key Aspects of the Rule