Alabama Medical Association Leads the Charge: Health Care Groups Unite for Prior Authorization Reform

MONTGOMERY, Ala. – Thirty health care organizations have teamed up with the Medical Association of the State of Alabama (MASA) to push for changes in health insurance rules about prior authorization. This process often leads to higher health care costs and even worsens health conditions or risks to life.

This initiative is part of MASA’s “Fix Prior Authorization” campaign, launched last August, aiming to reduce treatment delays caused by insurance providers.

William Kilgo, director of the Neuroimmunology and MS Clinic at USA Health in Mobile, expressed his frustration, saying, “We can no longer let paperwork and red tape stand in the way of effective medical care. Patients like mine deserve better.”

A recent survey by the American Medical Association found that 94% of doctors said prior authorization delayed patient care. Among 1,000 physicians surveyed, 24% noted that these delays harmed patients directly.

Amanda Williams, MASA president and a psychiatrist in Montgomery, mentioned that prior authorization tasks consume about 20% of her workday, often leading to unnecessary delays. She shared an example where an insurance company limited a patient’s medication to one tablet a day, even though the doctor prescribed more.

“These issues arise every day, ranging from simple prescription changes to urgent hospital needs that get held up,” she said.

MASA is advocating for 11 policy changes to make the prior authorization process more efficient. These include eliminating repeated prior authorizations for chronic illness patients and banning retroactive denial of claims after approvals. They also want health insurance companies to commit to responding to urgent requests within 24 hours and non-urgent requests within 48 hours. Currently, state law only requires a two-business-day response time for all requests.

Another important reform would prevent the exclusive use of artificial intelligence in making initial prior authorization decisions. This practice is becoming more common among insurers, but MASA emphasizes the need for human oversight in these critical decisions.

Blue Cross Blue Shield of Alabama, which dominates the state’s insurance market, does not use AI for prior authorization decisions, unlike some insurers in other states like Massachusetts and Florida.

MASA is actively meeting with insurance companies to discuss these reform priorities, and they feel positive about achieving results without needing new laws. Sophie Martin, a spokesperson for Blue Cross Blue Shield, confirmed ongoing collaboration with MASA to address these concerns.

“Our goal is to find common ground for safe and effective care for Alabamians,” she stated.

Williams pointed out that, due to its size, Blue Cross Blue Shield essentially sets the standard for insurance practices in Alabama. This central role brings both advantages and challenges for local providers.

“While they do many good things, their size means that a lot of the healthcare landscape is influenced by decisions beyond our control,” she noted.

Dr. Harry McCarty, a cancer care physician, added that the current system of prior authorizations creates severe obstacles for providing quality patient care: “There is almost nothing in medicine that is more obstructive than these barriers imposed by insurance companies.”