Essentia Health Cheers North Dakota Leaders for Transforming the Prior Authorization Process

On April 23, North Dakota took a significant step toward improving health care access by passing Senate Bill 2280. The bill aims to reform the prior authorization process, a method insurance companies use to approve medical services. This legislation has gained widespread support, thanks to a coalition of 20 health care and patient advocacy organizations, including Essentia Health and various medical professionals.

Prior authorization is meant to manage health care costs and ensure appropriate care. However, it often creates hurdles for patients. Delays in approval can lead to longer wait times for treatment and increase the likelihood of more complex, costly procedures later on. In many cases, what should be straightforward care turns into a drawn-out process, frustrating both patients and providers alike.

Dr. Stefanie Gefroh, president of Essentia’s West Market, expressed concerns about the impact of these delays. She noted that prior authorization can sometimes delay care by days or even weeks. This not only escalates treatments and costs but can also worsen health outcomes. Thanks to this new law, North Dakota has stepped up to tackle these obstacles.

Recent data from the American Medical Association highlights the burden prior authorization places on physicians. On average, doctors and their teams spend about 14 hours a week handling these requests—almost equivalent to two full business days. Alarmingly, 80% of those surveyed reported an increase in authorization requests over the past five years, with 92% saying these requests slow down care.

Before this reform, North Dakota lacked formal regulation of the prior authorization process, a situation that distinguished it from many other states. Now, the new law introduces essential changes:

• Timely Decisions: Insurers are required to respond to non-urgent requests within seven days and urgent requests within 72 hours. If they fail to respond in time, the request is automatically approved.

• Qualified Reviews: Denials must come from licensed physicians with relevant expertise, ensuring that patients get fair evaluations.

Senators and representatives across party lines championed this bill, demonstrating a collective commitment to improving health care access. By addressing these issues, North Dakota aims for a future where patients get the care they need without unnecessary delays.

For more information about this reform, you can read the full details from the North Dakota Legislature.

Check out this related article: Unlocking Global Health Insights: Omar Shilleh’s Vision for a Healthier World

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