Ask Congress to Support American Seniors' Right to Timely Access to Treatment.

Have you ever gone to the pharmacy to fill a prescription only to be told that your insurance company requires approval before they'll cover your treatment? Have you ever waited for days, weeks, or months for a test or medical procedure to be scheduled because your physician first needed to obtain authorization from your insurer?

This policy is called "prior authorization," and it's a tactic used by insurance companies to cut their costs and boost their profits by requiring physicians to obtain approval before a treatment qualifies for coverage. This burdensome process is confusing, time consuming, and — most importantly — can cause delays in patients receiving the care they need and could adversely impact clinical outcomes.

The AMA is working hard to fix "prior authorization." Bi-partisan legislation was recently introduced in the House of Representatives aimed at protecting patients from the burden of prior authorizations. The Improving Seniors' Timely Access to Care Act of 2019 (H.R. 3107) would reduce unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America's seniors. This bill takes meaningful steps to curb insurers' abuse of prior authorization requirements in order to save money, as well as protects patients from care disruptions.

Urge your representatives to support H.R. 3107 and improve seniors' timely access to healthcare today.

Subject: Fix prior authorization by supporting H.R. 3107

Dear Representative,

Bi-partisan legislation was recently introduced in the House of Representatives aimed at protecting patients from the burden of prior authorizations. The Improving Seniors' Timely Access to Care Act of 2019 (H.R. 3107) would reduce unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America's seniors.

Specifically, the bill would:

· Create an electronic prior authorization program including the electronic transmission of prior authorization requests and responses and a real-time process for items and services that are routinely approved;

· Improve transparency by requiring plans to report to Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials;

· Require plans to adopt transparent prior authorization programs that are reviewed annually, adhere to evidence-based medical guidelines, and include continuity of care for individuals transitioning between coverage policies to minimize any disruption in care;

· Hold plans accountable for making timely prior authorization determinations and providing rationales for denials; and

· Prohibit additional prior authorization for medically necessary services performed during a surgical or invasive procedure that already received, or did not initially require, prior authorization.

The demand and need for such reforms is growing - particularly as more seniors choose Medicare Advantage for their health insurance needs. According to a recent Kaiser Family Foundation report, Medicare Advantage enrollment has nearly doubled in a decade, and nearly four out of five enrollees are in plans that require prior authorization for some services.

Please join your colleagues and protect patients from delays in care and help relieve the unnecessary administrative burdens that consume valuable health care resources. Please support the Improving Seniors' Timely Access to Care Act of 2019 today!

To learn more visit: FixPriorAuth.org

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