What is Prior Authorization?

Check out the video below for an analogy:

Prior authorization (PA) is a cost management tool used by health insurance companies and other third-party payers in the healthcare system. It requires physicians to submit additional forms and documentation before the care they recommend for their patients will be approved for payment by the insurer.

The delays caused by this process can cause harm even if the PA request is ultimately approved. And when PA requests are denied, you may not be able to get the care you need at all. Your doctor can appeal, but this process is often difficult and time-consuming too, and may still result in a denial.

How bad is the problem? In a recent survey of more than 1,000 Illinois physicians, conducted by the Illinois State Medical Society, almost half reported waiting an average of three business days or more for PA determinations. The vast majority expressed frustration about the cumbersome process, lack of standardization and transparency, and PA requirements that are not consistent with current clinical guidelines. Almost every doctor surveyed (95%) believes that PA has a negative impact on patients, and more than 90% believe the burden has gotten worse in the last five years. (Read the full report here.)

What should we do about it?

Making prior authorization work for Illinois patients is going to require legislative action. The Illinois State Medical Society has identified several priorities we believe are critical to reforming prior authorization in Illinois, from streamlining the process and increasing transparency to ensuring that PA requirements are based on evidence-based criteria.

We are leading the charge, and will work with advocates representing physicians, other health professionals, and patients, to name a few. Our goal is to make prior authorization work for Illinois patients!

How can I help?

There are four ways you can help fix prior authorization in Illinois:

  1. Tell us your story. If you have personal experience with prior authorization, send us an email at communications@isms.org to tell us how it affected you. As we work with elected officials and negotiate with other stakeholders, having real stories from real patients is critically important to driving home the need for these reforms. Your name and other identifying information will be kept strictly confidential.
  2. Sign the petition below. Every signature helps to show elected officials that there is overwhelming support for fixing prior authorization.
  3. Call your legislators. Your elected officials will be hearing from us, but hearing from their constituents will remind them that this isn’t just a “special interest” issue – it’s affecting their friends and neighbors too. Urge them to support the Prior Authorization Reform Act (H.B. 5510 / S.B. 3822) and fix prior authorization for Illinois patients!
  4. Spread the word. Tell your doctor about this campaign, and tell your friends and family too. Encourage them to join you in taking these steps, and know that your voice matters!

Sign the petition! To lend your voice to our effort and receive updates on the status of our campaign, enter your name and email address below, along with a brief story about how prior authorization affects you:

Coalition Members

Illinois State Medical SocietyThresholdsArthritis FoundationIllinois Chapter of the American Association of Pediatrics LogoIllinois Section of the American College of Obstetricians and Gynecologists · Illinois Society of Eye Physicians and SurgeonsIllinois Society for Advanced Practice NursingAmerican Nurses AssociationIllinois Association for Behavioral HealthIllinois Academy of Family PhysiciansAmerican Cancer SocietyIllinois College of Emergency PhysiciansIllinois Hospital AssociationAmerican Association of Clinical UrologistsIllinois Primary Health Care AssociationIllinois Society of AnesthesiologistsIllinois Association of Orthopaedic SurgeonsNational Alliance on Mental Illness